Women Who Receive DXA Scans Should Request a Copy of Their Bone Density Results

Newswise — Sending bone density results directly to patients increases the likelihood that they will seek treatment and is a preferred method of physicians for communicating results, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.

DXA scans, commonly called bone density tests, are a way of determining if a patient has low bone mass, and is at increased risk for fracture. Bone density tests are often used for diagnosis and following the progression of osteoporosis, a disease that weakens the bones and makes them prone to fracture.

Osteoporosis affects an estimated eight million women and two million men in the Untied States. Studies show that many patients who are diagnosed with osteoporosis never receive treatment, and some are not even notified of their DXA scan results.

Researchers followed 370 women as a part of a four-year study. The participants were divided into two groups. The first group received a copy of their bone density results and information about osteoporosis prevention directly from the testing facility, while the second group received a letter asking them to follow up with their physicians.

In addition to following the participants, a survey was sent to 308 physicians who ordered at least four DXA scans to obtain feedback regarding the delivery of test results.

At the three to six-month follow-up, of those women identified by their bone density studies as having osteoporosis, 13 out of 14 who received their bone scan results directly from the testing center were taking prescription medication for osteoporosis. Only 8 out of 14 of those who received a letter requesting them to follow up with their physicians were taking prescription medication to treat osteoporosis.

Of the physicians who responded to the survey regarding test results delivery, ninety-six percent agreed that sending results directly to patients would increase the likelihood of patients seeking treatment. Eighty-five percent said patients would be more likely to discuss their test results with their physician if they received them directly.

"This study indicates that patients who are sent the results of tests are more likely to communicate with their providers and start appropriate therapy, said researchers Edward S. Leib, MD; professor, University of Vermont College of Medicine; director, The Osteoporosis Center, Fletcher Allen Health Care Ambulatory Care Center 5E and Teresa Fama, MD, MS; fellow, rheumatology, University of Vermont College of Medicine. "Despite concerns that patients who receive such results might misinterpret the findings, this study demonstrates that physicians did not object to findings being sent directly to patients and, that by having this done, it would likely encourage better communication with patients."

This study may have wider implications than just for bone density studies and this method of sending results directly to patients might be useful and acceptable for other types of testing results. The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.

Benefits of Reporting Bone Density Results Directly to Patients

Teresa A. Fama1, Priscilla Carr1, Edward Leib2. 1Central Vermont Medical Center, Berlin, VT; 2University of Vermont, Burlington, VT

Purpose: Studies show that many patients who are diagnosed with osteoporosis never receive treatment, and some are not even notified of their DXA scan results. We performed an IRB-approved two-part study to evaluate whether sending DXA results directly to patients influences subsequent osteoporosis treatment, and to assess referring providers' opinions of this DXA reporting process.

Methods: Women presenting to our osteoporosis center for their first DXA were eligible to enroll in the study. BMD was measured on a GELunar Prodigy densitometer (GELunar, Madison, WI). Following their DXA, women were randomized to receive either: (1) a copy of their results and additional information about osteoporosis prevention (Group 1); or, (2) a letter stating they should contact their referring provider for results (Group 2).

A total of 616 providers ordered DXA scans through our center over a four-year period. For the referring provider portion of the study, a survey was sent to the 308 providers who ordered at least 4 scans (median number). We received 96 surveys for a response rate of 31%.

Results: 370 women were equally and randomly enrolled in Groups 1 and 2. The majority was college-educated and almost all had health insurance. Baseline characteristics of the two groups were similar. At 3 to 6-month follow-up, 13 of 15 women in Group 1 with a T-score ≤ -2.5 were taking prescription medication for osteoporosis, while only 8 of 15 women in Group 2 with a T-score of ≤ -2.5 were taking prescription medication (p=0.029). Over half the women in Groups 1 and 2 were consuming dairy or calcium and vitamin D supplements prior to testing, and there was no difference in calcium and vitamin D intake between the two groups after DXA testing.

Of the 96 referring provider respondents, three-quarters practiced primary care (43% family practice and 28% general internal medicine), 59% were women, and the average number of years in practice was 16. 96% of responders agreed with sending DXA results directly to patients. Only 6% of responders would rather have notified patients themselves of the results. Moreover, 85% of responders thought that it was more likely for patients to discuss DXA results if their patients received results directly from the testing center.

Conclusions: Directly sending patients their DXA results increased the likelihood that prescription medication was started to treat osteoporosis. Direct contact did not seem to have an appreciable effect on the use of calcium and vitamin D supplements, perhaps because a large percentage of patients were already taking supplements prior to the DXA. Almost all (96%) responders to the provider survey agreed with sending results directly to patients, and most thought that this process increased the likelihood of discussing osteoporosis treatment with their patients at follow-up appointments.

Disclosure Block: T.A. Fama, None; P. Carr, None; E. Leib, None.