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Clinical Applications

David W. Bates, MD,MSc; Dennis M. Black, PhD; Steven R. Cummings, MD

JAMA. 2002;288:1898-1900.

Osteoporosis represents a difficult problem for physicians because, although many diagnostic tests are available, interpreting their results is not straightforward. As a result, many patients, even those with clear indications such as long-term steroid therapy or vertebral fractures on radiography, do not get screened or treated. Current evidence-based guidelines recommend screening for all white women older than 65 years and not already receiving an osteoporosis treatment and for many nonwhite women. For postmenopausal women who are younger than 65 years and have strong risk factors for osteoporosis, screening may also be beneficial. The optimal testing strategy depends on what is available locally. The best role for follow-up testing is still being defined, and interpretation of such testing is tricky. Reports of results can be hard to understand; a randomized controlled trial of clearer reports increased testing and decreased confusion about the meaning of test results. Densitometry might be more effectively used in practice if strategies such as having patients fill out a short questionnaire to assess for risk factors or creating a nurse-based system were used to identify patients. Clinicians need better approaches for identifying patients most likely to benefit from screening, systems that facilitate their application, and test results that are easy to interpret.

Author Affiliations: Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, and the Center for Applied Medical Information Systems Research, Partners Healthcare Systems, and Harvard Medical School, Boston, Mass (Dr Bates); and the UCSF Coordinating Center, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco (Drs Black and Cummings).

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