BMD, mammography screening rates well below current recommendations
By Laura Dean
29 June 2011
Menopause 2011; 18: 794–801

MedWire News: Use of bone mineral density (BMD) and mammography screening is low in relation to guideline recommendations, a study of nearly 1 million US women with employer-sponsored health insurance has shown.

The researchers found uptake of BMD or mammography screening among eligible women was less than 25%, but that those who used additional health screening services were more likely to be compliant with the guidelines.

Eric Meadows (Eli Lilly and Company, Indianapolis, Indiana, USA) and colleagues used employers' administrative claims data to examine the use of mammography and BMD screening among 954,111 women aged 50 years and older between 2004 and 2006.

The researchers categorized the women into five groups according to the screening they were eligible for under current guidelines: age-motivated BMD screening (age >65 years), fracture-motivated BMD screening, mammography, age-motivated BMD screening plus mammography, or fracture-motivated BMD screening plus mammography.

Compliance with osteoporosis screening was "very low," with only 27% and 16% of women complying with age- and fracture-motivated BMD testing, respectively.

Compliance was also low for mammography, at 21%.

Meadows and team observed that women who received a mammogram were more likely to be compliant with both age- and fracture-motivated screening than those who did not, with respective odds ratios (ORs) of 6.01 and 2.20.

Similarly, BMD screening use was associated with increased compliance in the mammogram cohort (OR=7.19 vs no BMD screening).

In all five study cohorts, estrogen use was associated with increased compliance with screening, with ORs ranging from 1.08 for fracture-motivated BMD to 3.30 for mammography plus age-motivated BMD.

Writing in the journal Menopause, the researchers say that their findings have at least two possible explanations. "One is that women who engage in one kind of preventive care behavior are more likely to engage in another," they say.

"It is also possible that compliant women are receiving care from physicians who are more likely to follow recommended guidelines."

Either way, "methods to improve adherence to mammography and BMD screening guidelines should be explored, which could possibly leverage the increased likelihood that women who receive one screening service will receive another," Meadows et al conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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