BMD results and repeated testing alone provide little if any value to drive long term management decisions. BMD should be used as a supporting tool only. - (Toward Optimized Practice, Summary of the Clinical Practice Guideline | February 2016)
Don’t repeat Dual Energy X-ray Absorptiometry (DEXA) scans more often than every 2 years
The use of dual-energy x-ray absorptiometry (DEXA), can be a valuable and important tool in the diagnosis of osteoporosis and assess a patient’s risk of fractures. However, the indications for DEXA scan are dependent on multiple factors including presence of risk factors and whether they are on a treatment for osteoporosis. Scans done at short intervals (< 2 years apart) provide little if any value in guiding long-term management and therefore offer little to no value. The aim of this study was to determine the utilization of DEXA scans in Alberta. We analyzed the rate at which short-interval, DEXA scans were being ordered. Determining baseline utilization and the number of short-interval tests performed, informed by the Choosing Wisely Canada recommendation, will be necessary to determine the extent of the problem.
17% (62, 525) were done less than two years apart
368,256 DEXA scans were performed costing more than $8.5 million
Alberta Health (AH) data analysts identified patients from the Physician Claims Fee-For-Service database who had a DEXA scan in a 3 year time period. The data was analyzed by age, gender and short-interval tests.
Outcome and Results
During the 3-year period (2013-2015), there were 310,060 DEXA scans performed in Alberta, 21.2% (65,922) were ordered on the same patient less than 2 years apart. There was significant variation in the rate of repeat scans ordered across the five health zones ranging between 14.0% (North Zone), and 21.3% (Edmonton Zone). The number and rate of repeat scans declined in all regions, and a 5% decline overall in Alberta over the 3-year period. Repeat scans were ordered more often (2015) in women (20.6%) than in men (11.9%), and more frequently by practitioners in specialty care compared to primary care. Variation in DEXA utilization exists among health zones and directing programs aimed at reducing unnecessary tests could be most effective. Women are more likely to receive DEXA scans, but given the rate of osteoporosis in men (1 in 5 for men over 65), this a patient population that is under-screened. These results provide baseline data with which to evaluate the effectiveness of strategies, such as Choosing Wisely, aimed at reducing the number of low value, repeat DEXA scans.
Screening rate of men and women in Alberta (2000-2015)
What age to begin screening?
Over 50 with any of the following risk factors
- Bone broken in an accident
- Rheumatoid arthritis
- Parent broke a hip
- Low body weight
- > 3 months of corticosteroid use
- Disorder associated with osteoporosis
- Heavy drinker
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