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- Background: Current osteoporosis screening guidelines recommend bone mineral density (BMD) testing following fragility fractures. Despite the existence of such guidelines, previous studies have demonstrated that rates of osteoporosis screening remain low. Diagnosis and treatment of osteoporosis is essential for prevention of future fractures. In this study, we hypothesized that there are low rates of BMD testing for menopausal women following a distal radius fracture (DRF).
Methods: We queried a national insurance claims database to identify menopausal women aged 45 to 64 with a DRF between 2013 and 2020. We calculated the rate of BMD testing within 1 year of injury. We used a multivariable logistic regression analysis to evaluate the extent to which patient- and injury-related variables affect the likelihood of undergoing BMD testing following DRF.
Results: Among 31,708 patients (mean [SD] age, 57.5 [4.3]), 3,888 (12.3%) received a BMD test within 1 year. Average time between fracture and BMD testing was 143 ± 102 days (range 1-365 days). In multivariable logistic regression analysis, the strongest predictive factor of BMD testing within 1 year was age, with increasing likelihood of testing for each subsequent age group: age 50-54 (OR, 1.86 [1.45-2.37]), age 55-59 (OR, 2.22 [1.73-2.79]), and age 60-64 (OR, 2.87 [2.24-3.60]). Patients that had surgical intervention were also more likely to have testing (OR, 1.29 [1.16-1.43]). Elixhauser Comorbidity Index was not associated with BMD testing however patients with certain conditions had increased odds of testing including those with rheumatoid arthritis (OR, 1.25), osteoarthritis (OR, 1.26), breast cancer (OR, 1.29), and vitamin D deficiency (OR, 1.29). Factors associated with decreased odds of BMD testing included tobacco use (OR, 0.89 [0.83-0.96]), Medicaid (OR, 0.74 [0.62-0.87]) or Medicare (OR, 0.75 [0.64-0.87]) insurance, and patients in the South (OR, 0.68 [0.63-0.74]) or West (OR, 0.69 [0.61-0.77]) regions. Other osteoporosis risk factors such as obesity, diabetes, renal disease, and early menopause were not associated with BMD testing.
Conclusions: Despite the publications of osteoporosis screening guidelines, rates of BMD testing are low (12.3%) among menopausal women with DRF and are decreasing annually. Older age and surgical intervention increased likelihood of BMD testing while patients with Medicaid or Medicare and patients living in the South and West regions were less likely to have testing indicating the presence of additional socioeconomic factors influencing BMD testing. Known osteoporosis risk factors did not reliably predict likelihood of BMD testing. Further research is needed to investigate barriers to testing.
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