Researchers identified certain factors that are associated with the use of using dual-energy x-ray absorptiometry (DXA) in women within 5 years of receiving anti-osteoporosis therapy, although bone mineral density (BMD) monitoring during this period remains controversial, according to study results published in the Journal of Clinical Densitometry.
Guidelines differ in recommendations for the use of routine BMD monitoring after treatment initiation for osteoporosis. To identify factors associated with BMD monitoring during the first 5 years of receiving anti-osteoporosis medication in the context of a routine clinical setting, researchers used population-based registries in Manitoba, Canada, to follow 6877 women who were monitored for BMD (mean age, 64.9 years; mean interval from baseline assessment to DXA, 3.2 years) and 6747 who were not monitored (mean age, 71.8 years). The researchers found a significant negative secular trend in BMD monitoring across the study period (P <.001).
Overall, women who underwent monitoring were more likely to have received glucocorticoid therapy (7.8% vs 6.8%; P =.027) or aromatase inhibitors (3.6% vs 2.3%; P <.001). Women who did not receive a DXA scan in the 5-year period were more likely to have prior fracture (24.4% vs 18.5%; P <.001), osteoporosis based on minimum T-score (60.5% vs 56.7%; P <.001), and diabetes (9.7% vs 4.7%; P <.001). They also had lower baseline femoral neck T-scores (mean scores, -2.1 vs -1.9; P <.001).
Using multivariable logistic regression, the researchers found parental hip fracture, glucocorticoid and aromatase inhibitor use, and lower baseline BMD to be positively associated with BMD monitoring with DXA (odds ratio [OR] >1). Conversely, negative associations (OR <1) existed for older age, greater body mass index, smoking, rheumatoid arthritis, diabetes, rural residency, lower income, and greater comorbidity scores.
Furthermore, a shorter monitoring interval (<23 months) occurred in 533 women and was significantly associated with glucocorticoid and aromatase inhibitor use (adjusted ORs, 4.89 and 8.68, respectively).
Study limitations included a lack of standardization in BMD testing intervals in clinical practice.
Summarizing their results, the researchers said, “We found that BMD monitoring of women receiving anti-osteoporosis therapy is commonly performed within 5 [years]…. The factor most strongly associated with monitoring (especially a monitoring interval <23 mo) was aromatase inhibitor therapy for women with breast cancer.”
Leslie WD, Morin SN, Martineau P, Bryanton M, Lix LM. Factors associated with bone density monitoring while on antiosteoporosis treatment in routine clinical practice: a registry-based cohort study [published online March 21, 2019]. J Clin Densitom. doi:10.1016/j.jocd.2019.03.006