Osteoporosis screening outreach trial: the role of the primary care physician

Abstract

Objective: Screening and treatment rates for osteoporosis are low despite high prevalence and morbidity. The purpose of this study was to determine the impact of primary care physician (PCP) review and signature on a letter outreach campaign to promote densitometry (DXA) in a group of high-risk postmenopausal females. Methods: Computerized records of more than 35,000 women aged 55 years and older were obtained. Inclusion criteria were weight less than 127 pounds and current cigarette smoking. Exclusion criteria were prior DXA or having received a bone-protective drug during the past 3 months. Women with an odd record number had their letter sent to their PCP to review for clinical appropriateness and signature. Those with an even number were sent a letter with the name of the chief at the bottom. Results: DXA was done in 10% (37/364) of the PCP group and 20% (67/339) of the non-PCP group. The DXA results (PCP versus non-PCP) were: osteoporosis (54%, 41%), osteopenia (37%, 39%), and normal (8%, 19%). Among patients with osteoporosis, treatment was dispensed to 40% of the PCP patients versus 53% of the non-PCP patients. Among patients with osteopenia, treatment was dispensed to 36% of the PCP patients versus 42% of the non-PCP patients. Thirty-seven patients in both groups were dispensed bone-protective drugs (almost exclusively estrogen) despite not undergoing DXA. Conclusion: Screening rates were low but consistent with prior outreach campaigns. Involving the PCP substantially reduced the response rate. Treatment rates were low in both groups, but higher in the non-PCP group. Many women in both groups began bone- protective drug therapy following the letter despite not having DXA.