Assessment of risk factors given in GP referral letters for DEXA imaging

Abstract

Osteoporosis poses a significant public health issue, causing significant morbidity and mortality. It leads to an increased fracture risk through a reduction in the bone mineral density (BMD), disruption of bone microarchitecture, and alteration of the amount and variety of noncollagenous proteins in bone. Treatment aims are to prevent fractures and maintain the quality of life of the aging adult. The advent of the WHO assessment tool ‘‘Fracture Risk Assessment Tool’’ (FRAX ) has been revolutionary in GP assessment of patients regarding need for treatment, need for further evaluation by dual-energy X-ray absorptiometry (DXA) imaging and those not requiring any treatment [1]. In response to this we conducted a retrospective audit to examine GP requests for DXA imaging and if they contain sufficient details to justify imaging. All requests were prior to the launch of FRAX . Two hundred randomly chosen GP request letters were analysed using the FRAX tool. All letters were from April 2007 to July 2008. Resulting data were analysed using the statistical package SPSS version 14.0. Of the 200 letters, 8 (4%) were male and 192 (96%) were female, with a mean age of 64.3 years. One GP service provided a proforma referral letter with the remaining letters being individually composed. Table 1 shows the percentage of letters containing each of the FRAX criteria. Of importance only one request (not a proforma letter) contained all the details allowing for FRAX assessment (p \ 0.005) despite the use of a proforma by one GP service. In conclusion, from this audit we can see that the majority of GP referral letters for DXA imaging do not contain adequate data to make recommendations using the FRAX tool. Incorporating this data into referrals is likely to improve requesting systems for DXA scanning to GPs. In the future it is planned to develop a proforma referral letter, containing a full FRAX assessment, for GPs requesting DXA scanning, and also to carry out a further study to assess if the advent of FRAX has improved GP awareness of osteoporosis risk factors. In the intervening period it is planned to ask patients, presenting for DXA