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Bates DW, Black DM, Cummings SR. Clinical Use of Bone Densitometry: Clinical Applications. JAMA. 2002;288(15):1898–1900. doi:10.1001/jama.288.15.1898
Author Affiliations: Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, and the Center for Applied Medical Information Systems Research, Partners Healthcare Systems, and Harvard Medical School, Boston, Mass (Dr Bates); and the UCSF Coordinating Center, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco (Drs Black and Cummings).
Scientific Review and Clinical Applications Section
Editor: Wendy Levinson, MD, Contributing Editor. We encourage authors
to submit papers to "Scientific Review and Clinical Applications." Please
contact Wendy Levinson, MD, Contributing Editor, JAMA; phone: 312-464-5204;
fax: 312-464-5824; e-mail: email@example.com.
Osteoporosis represents a difficult problem for physicians because,
although many diagnostic tests are available, interpreting their results is
not straightforward. As a result, many patients, even those with clear indications
such as long-term steroid therapy or vertebral fractures on radiography, do
not get screened or treated. Current evidence-based guidelines recommend screening
for all white women older than 65 years and not already receiving an osteoporosis
treatment and for many nonwhite women. For postmenopausal women who are younger
than 65 years and have strong risk factors for osteoporosis, screening may
also be beneficial. The optimal testing strategy depends on what is available
locally. The best role for follow-up testing is still being defined, and interpretation
of such testing is tricky. Reports of results can be hard to understand; a
randomized controlled trial of clearer reports increased testing and decreased
confusion about the meaning of test results. Densitometry might be more effectively
used in practice if strategies such as having patients fill out a short questionnaire
to assess for risk factors or creating a nurse-based system were used to identify
patients. Clinicians need better approaches for identifying patients most
likely to benefit from screening, systems that facilitate their application,
and test results that are easy to interpret.
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