Reasons for referral to bone densitometry in men and women aged 20-49 years: population-based data.

INTRODUCTION: Osteoporosis poses a significant public health problem for ageing Australians. However, approximately 25 % of Australian adults aged 20-49 years have osteopenia, a precursor condition to osteoporosis. Despite this, little is known about bone density testing in this age group. METHODS: Reasons for referral to dual energy X-ray absorptiometry (DXA) were examined in 2,264 patients aged 20-49 years, referred in 2001-2010 to the Geelong Bone Densitometry Service, Geelong Hospital, Victoria. Referral reasons were determined from clinical indication codes derived from patient records. Age, sex and bone mineral density (BMD) T scores were ascertained for each patient. RESULTS: The most common reason for referral for women reflected glucocorticoid use, and for men reflected fracture. Compared to women, men were more likely to have been referred because of minimal trauma fracture or low BMD (41.7 versus 27.1 %, p < 0.001). No further differences were identified between the sexes, with similar numbers of referral observed for secondary osteoporosis, and monitoring of drug therapy. At the spine, and for all indications, men had a significantly greater BMD deficit compared to women (all p ≤ 0.002). After age adjustment, men who were tested due to fracture or glucocorticoid reasons had significantly greater BMD at the total hip (p ≤ 0.03). No further associations were seen after age adjustment between referral reason and BMD. CONCLUSIONS: Our study presents the first data examining reasons for referral to DXA among Australians aged 20-49 years. Understanding health service utilisation regarding bone health in young adults is fundamental to understanding future risk, informing effective public health messages and raising awareness of osteoporosis

Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia

SummaryIn 2007, Medicare Australia revised reimbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged &ge;70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low.IntroductionOn April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged &ge;70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division.MethodsProportions of DXA referrals 2003&ndash;2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged &ge;70 years referred to the major public health service provider for DXA clinical purposes (n&thinsp;=&thinsp;6,096; 21 % men).ResultsDXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p&thinsp;&lt;&thinsp;0.001). For 2003&ndash;2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007&ndash;2010 were 1:2.3 to 1:3.4. Referral ratios &lt;2007:&ge;2007 were 1:1.7 for men aged 70&ndash;79 years (p&thinsp;&lt;&thinsp;0.001), 1:1.2 for men aged 80&ndash;84 years (p&thinsp;=&thinsp;0.06), and 1:1.3 for men 85+ years (p&thinsp;=&thinsp;0.16). For women, the ratios &lt;2007:&ge;2007 were 1:2.1 (70&ndash;79 years), 1.1.5 (80&ndash;84 years), and 1:1.4 (85+ years) (all p&thinsp;&lt;&thinsp;0.001).ConclusionsDXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007&ndash;2010 vs. 2003&ndash;2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.<br /

Fifteen years of research with the Staff Observation Aggression Scale; A review

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