'Due' for a Bone Density Test: Time to Reconsider

July 24, 2013

By Megan Brooks

NEW YORK (Reuters Health) Jul 24 - It's time to reconsider routine bone density tests in women on a bisphosphonate for low bone mineral density (BMD) because they rarely lead to a change in treatment, researchers say.

"Clinicians often obtain dual-energy x-ray absorptiometry (DXA) tests in patients on prescription treatment for low bone density out of a sense that the test is 'due', rather than in response to a specific clinical concern," Dr. Brandon P. Combs of the University of Colorado School of Medicine in Aurora told Reuters Health.

"We observed infrequent treatment changes even when the test showed a significant decrease in bone density, a finding you might think would lead to a change in treatment. Our results suggest that many of these 'monitoring' tests may have been unnecessary," he said.

In a Research Letter online July 22 in JAMA Internal Medicine, Dr. Combs and three colleagues say they examined the medical records of 92 women receiving bisphosphonate therapy for low BMD who had a total of 192 monitoring DXA scans. On average, the women were 68 years old and each received three scans with an interval of 2.4 years between scans.

Records showed that the primary rationale for ordering scans was that they were "due" (177 of 196 scans, or 90%). Most scans (165, or 84%) resulted in no treatment changes. Even among the 36 scans showing a significant decrease in BMD, 26 (72%) resulted in no change in treatment.

The researchers say they suspect that the frequency of monitoring DXA reflects adherence to professional guidelines, many of which recommend routine monitoring every one or two years while the patient is receiving treatment.

"Nonetheless, clinicians may feel uncomfortable escalating treatment on the basis of BMD changes because decreases in BMD during treatment do not reliably predict future fracture risk. Notably, most patients who lose BMD during the first year of treatment regain much of that in the following year even if the treatment is not changed," they point out.

Is a change in clinical practice in order? "Yes," Dr. Combs told Reuters Health.

"Our study adds to the existing body of literature which calls into question the routine use of monitoring bone density tests in patients already on prescription treatment. We are concerned that many monitoring bone density tests may be performed without sufficient attention to the question of - will the test result change my care of the patient?"

"Precisely how often monitoring bone density tests should be obtained is uncertain, though our obligation to avoid unnecessary tests and procedures in our patients mandates that we reconsider routine use of monitoring bone density tests in patients already on treatment," Dr. Combs said.

The authors have no conflicts of interest. The study was presented as an abstract at the Annual Meeting of the Society of General Internal Medicine in April 2013.

SOURCE: http://bit.ly/13DMIf3

JAMA Intern Med 2013.


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