How Pharmacists Can Improve Osteoporosis Screening in Women

Women with the greatest risk for osteoporosis are not being screened enough, while those at less risk are being screened too often.

The US Preventive Services Task Force (USPSTF) advises all women aged 65 years or older—as well as younger women with a history of smoking, rheumatoid arthritis, alcohol abuse, and other high risk factors—to be screened for osteoporosis using dual-energy x-ray absorptiometry (DXA).

However, a recent study retrospectively observing nearly 51,000 women aged 40 to 85 years in a regional health-system found only 58.8% of those aged 60 to 64 years with 1 or more risk factors, 57.8% of women aged 65 to 74 years, and 42.7% of women aged 75 years or older were screened for osteoporosis over a 7-year period.

Meanwhile, among the groups in which USPSTF said such screening would not be necessary, 45.5% of women aged 50 to 59 years and 58.6% of women aged 60 to 64 years without risk factors were screened.

These findings led the study authors to conclude DXA screening is underused in women at increased risk for fracture, yet “common” among younger women at low risk for osteoporosis, in whom screening may be unnecessary.

In an exclusive interview with Pharmacy Times, lead author Anna Lee Amarnath, MD, MPH, said pharmacists are in a “great position” to provide information about preventive screenings.

She suggested that pharmacies could display information about osteoporosis screenings in areas where patients wait for prescriptions to be filled, or pharmacists could give handouts to women to take home with them.

“But pharmacists also have the ability to identify women who might meet criteria for screening—such as women over the age of 65, or women who are being prescribed certain medicines that increase their risk of osteoporosis—and can offer counseling regarding screening to those women,” Dr. Amarnath said. “Pharmacists understand screening guidelines and are able to answer many questions women may have.”

Pharmacists can also encourage hesitant women to talk about osteoporosis screening with their health care providers if they are aged 65 years or older, or have high risk factors.

“These types of interventions may help ensure women receive appropriate screening can lead to improved health outcomes,” Dr. Amarnath said.

The researchers noted DXA screening has been named one of the most commonly misused diagnostic tests or treatments by the American Academy of Family Physicians and the American College of Physicians.

Another finding from the study, which was published in The Journal of General Internal Medicine, was African-American women were less likely to be screened than white women. In addition, women who had secondary osteoporosis, previous high-risk fracture, or rheumatoid arthritis were more likely to be screened. Those who visited their primary or specialty care providers or endocrinologist were more likely to be screened, as were women who had undergone a mammogram during the study period.

“Additional research is needed to elucidate patient, physician, and health-system barriers to evidence-based screening, so that interventions can maximize the value of population screening for osteoporosis,” the researchers concluded.

They noted some providers may be “uncertain or doubtful” about screening recommendations, while others may see screening in postmenopausal women as having a low risk of harm. Patients may also be asking their providers to be screened.

“Interventions may be needed to augment the value of population screening for osteoporosis,” the study authors wrote.