AGS 2009: Elderly Black Women Have Low Rate of Bone-Density Screening

Kathleen Louden

May 05, 2009

May 5, 2009 (Chicago, Illinois) — The densitometry screening rate is less than 16% in postmenopausal black women with risk factors for osteoporosis, and primary-care physicians are even less likely than specialists to order bone-density scans, according to a study presented here at the American Geriatrics Society Annual Scientific Meeting.

Physicians at a community health center who were surveyed rated osteoporosis a low health concern for their black female patients, and just 15.9% of 402 women in the study underwent screening with dual-energy X-ray absorptiometry (DXA), said lead author Youngdoo Chang, MD, a second-year resident at Huron Hospital, a Cleveland Clinic hospital in Beachwood, Ohio.

All women in the study were 65 years or older and had risk factors for osteoporosis identified in their medical records at the community health center.

"Doctors are not ordering DXA scans in black women who have risk factors for osteoporosis, even though [previous research has shown that] African American women have a higher mortality after osteoporotic fracture, compared with whites," Dr. Chang told Medscape Internal Medicine in an interview.

Furthermore, the prevalence of diagnosed osteoporosis was high — 29.6% — in the women who did undergo DXA, the authors report in their poster abstract. The prevalence was higher than that reported in other studies, Dr. Chang said.

Barriers to Ordering DXA

Physicians in the study were less likely to order DXA screening if the patient did not have private insurance. Although the authors did not ask physicians their reasons for not ordering DXA, Dr. Chang said it appears that there is a misperception that this test is not reimbursable.

Another barrier to DXA screening was old age, according to the abstract. The average age of women who received bone-density screening was 71 years, whereas the average age of the women who did not undergo the procedure was 75 years.

Physicians were asked to rank the following medical categories according to their priorities: colon cancer, breast cancer, hyperlipidemia, Papanicolaou test, domestic violence, substance abuse, and osteoporosis. Ordering colonoscopies and mammograms were the highest priorities of physicians in this study.

The prevalence of osteoporosis in postmenopausal women is 4% in blacks and 8% in whites, which might have influenced physician priorities, Dr. Chang said.

"If the attending physician views DXA as a high priority, the patient is more likely to get one," he said. "We need to increase physician education about the need for DXA in black women who have risk factors for osteoporosis."

Possibly, a lack of recognition of osteoporosis risk factors contributed to the low rate of DXA screening in this study, the abstract states.

Specialists such as geriatricians and rheumatologists were more likely to order DXA screening scans than were primary-care physicians, the results showed.

Study Limitations

A limitation of the study was that it assumed, but did not know for sure, that the women who did not undergo DXA did not have a physician referral for it.

Also, at 402 participants, the study lacked sufficient power, Ruxandra Jadic, MD, a geriatrician from the South Arkansas Center on Aging in El Dorado, told Medscape Internal Medicine. She viewed the poster but was not affiliated with the study.

Still, Dr. Jadic agreed that better physician education is needed. "Primary-care physicians and other doctors need to be more aware that osteoporosis is a problem in black women and that they are more likely to die after fracture," she said. "Doctors should look at their referral habits to make sure there is no bias."

In her clinical experience in a rural population, black patients tend to be more resistant to any kind of preventive screening, Dr. Jadic said, so she believes public education is needed as well.

Dr. Chang and Dr. Jadic have disclosed no relevant financial relationships.

American Geriatrics Society (AGS) 2009 Annual Scientific Meeting: Abstract A80. Presented April 30, 2009.