Understanding Referral Patterns for Bone Mineral Density Testing among Family Physicians: A Qualitative Descriptive Study

Table 3

Uncertainty about bone mineral density testing intervals.

Interview 2	Then I’ll see when they’ve had their last bone density and I’ll say “well you just had one two years ago, you’re on treatment, it was stable from the year before, and I don’t think you need one.” Well why shouldn’t we do one? Then I’ll say “well is it going to change your management in any way” What does usually happen is that they usually win
Interview 3	Her last BMD was a year and a half ago. I sent her for another one just to monitor her therapy. I mean we don’t really have any clear guidelines as to what we should be doing for patients that are on therapy. So we send them for a BMD to look at change.   This usually comes up when we have our annual physical
Interview 5	You order a bone density a year later and you want to see whether or not the treatment has worked. To be significant gain for the lumbar spine, it’s 3% and for the hip it’s 5% to 6%. If they’re not getting those gains within a year, I might decide to change … the method in which it’s administered
Interview 6	She had one done about three years ago and it showed osteopenia. We just opted for calcium and vitamin D. She was in the office the other day with her new BMD that it showed it was pretty stable. So we’re still continuing with the same management
Interview 7	If a patient was started on something, then I usually repeat [the BMD test] after a year. If the BMD is stable then I’ll repeat it maybe after three years
Interview 8	And follow up, the first time I put them on medication, I’ll follow up in two years. The ones that are normal, it’s every five years
What the 2010 Canadian CPGs for the diagnosis and management of osteoporosis indicate.	(i) “For patients who are undergoing treatment, repeat measurement of BMD should initially be performed after one to three years; the testing interval can be increased once therapy is shown to be effective. If BMD has improved or remains unchanged, the patient is considered to have had a good response to therapy”
	(ii) The definition of good response to treatment needs to be better communicated by guidelines, along with the duration of time that is needed to reliably gauge effectiveness