UMass Chan Medical School Faculty Publications


Effect of self-referral on bone mineral density testing and osteoporosis treatment

UMMS Affiliation

Department of Quantitative Health Sciences

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Absorptiometry, Photon; Age Factors; Aged; Aged, 80 and over; *Bone Density; Comorbidity; Continental Population Groups; *Diagnostic Self Evaluation; Female; Humans; Mass Screening; Osteoporosis; Patient Education as Topic


Community Health and Preventive Medicine | Health Services Research | Musculoskeletal Diseases | Public Health Education and Promotion | Women's Health


BACKGROUND: Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening.

OBJECTIVE: To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referral plus patient educational materials; and (3) usual care (UC, physician referral).

RESEARCH DESIGN: Parallel, group-randomized, controlled trials performed at Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Georgia (KPG). SUBJECTS: Women aged 65 years and older without a DXA in past 5 years.

MEASURES: DXA completion rates 90 days after intervention mailing and osteoporosis medication receipt 180 days after initial intervention mailing.

RESULTS: From > 12,000 eligible women, those randomized to self-referral were significantly more likely to receive a DXA than UC (13.0%-24.1% self-referral vs. 4.9%-5.9% UC, P < 0.05). DXA rates did not significantly increase with patient educational materials. Osteoporosis was detected in a greater proportion of self-referral women compared with UC (P < 0.001). The number needed to receive an invitation to result in a DXA in KPNW and KPG regions was approximately 5 and 12, respectively. New osteoporosis prescription rates were low (0.8%-3.4%) but significantly greater among self-referral versus UC in KPNW.

CONCLUSIONS: DXA rates significantly improved with a mailed invitation to schedule a scan without physician referral. Providing women the opportunity to self-refer may be an effective, low-cost strategy to increase access for recommended osteoporosis screening.

DOI of Published Version



Med Care. 2014 Aug;52(8):743-50. doi: 10.1097/MLR.0000000000000170. Link to article on publisher's site

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Medical care

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