Background/Purpose:  Osteoporosis is a silent disease until it is complicated by fractures. Fractures are common; they place an enormous medical and personal burden on the elderly and take a major economic toll on the nation. Despite this fact, screening for osteoporosis by DXA scan remains inadequate mainly because most patients are unaware of its importance. We found that the rate of DXA scan completion by patients who visited our hospital’s outpatient medical clinic was only 23.6% of all eligible women ≥65 years. The objective of this study was to identify specific patient barriers that prevent patients from completing a DXA test ordered during a clinic visit.

Methods: Between December 2014 and March 2015 DXA scans were appropriately ordered for 133 women ≥65 years who had visited the Rochester General Hospital medicine clinic; 75 completed the recommended DXA scan and 58 patients did not.  A retrospective chart review of the 58 non-compliers showed that 13 of them had completed DXA at a much later date, 3 had died, 4 switched PCP to outside practice; these patients were excluded.  We conducted a structured telephonic interview of the remaining 38 patients with the help of a barrier related questionnaire: • Are you aware you have DXA scan ordered? • If yes, did you schedule the appointment? • Do you use wheelchair, cane or walker for ambulation? • Do you have transportation issues? • Do you have problems with child care / elder care? • Are you working / retired? All patients were counseled on the importance of osteoporosis screening at the end of the interview Of the 38 patients we attempted to call, 3 refused to continue the conversation, 2 were hospitalized for critical illness, 3 Nepali speakers could not answer the questions, even with the help of an interpreter, 3 did not answer despite >2 phone calls. That left us with 25 effective calls. Of the 25 patients with completed surveys (none of whom had completed a recommended DXA scan), 72% (18/25) were up to date with mammography and 68% (17/25) had completed colonoscopy testing. 80%(20/25) were insured by medicare/medicaid and 84%(21/25) were retired

Results:  Based on the structured questionnaire we were able to identify several patient barriers to osteoporosis screening: • 72% (18/25) of patients reported lack of awareness that a DXA test was ordered.   • 24% (6/25) reported lack of transportation to go for the test • 20%(5/25) cited health issues • 4%( 1/25) had to care for an elderly family member • 36%(9/25) used a cane/wheelchair/walker for ambulation.

Conclusion:  The main patient related barrier to osteoporosis screening is patients’ lack of awareness about osteoporosis, the reason for screening and the consequences of osteoporosis if left untreated. Patients are usually asymptomatic and believe that weak bones are a part of ageing naturally. There is also lack of effective physician patient communication and counseling on osteoporosis. The fact that most patients who failed to complete their DXA scan are up to date with other screening tests such as colonoscopy and mammography suggest that non-compliance is not the only reason for poor rates of osteoporosis screening

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-barriers-to-osteoporosis-screening-in-a-medical-clinic-why-underserved-patients-who-follow-recommendations-for-colonoscopy-and-mammography-fail-to-get-their-dxa/