E-Poster Presentation 30th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2020

Dual energy x-ray absorptiometry reporting displays lack of adherence to international guidelines (#103)

Alicia R Jones 1 2 , Maylyn Goh 2 , Fran Milat 1 3 , Peter R Ebeling 1 4 , Amanda J Vincent 1 2
  1. Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia
  2. Monash Centre for Health Research and Implementation (MCHRI), Monash University, Clayton, Victoria, Australia
  3. Hudson Institute of Medical Research, Melbourne, Vic, Australia
  4. Department of Medicine, Monash University, Clayton, Victoria, Australia

Introduction: Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), is the gold standard for diagnosis of osteoporosis, however the utility of DXA relies on adequate reports. The International Society for Clinical Densitometry (ISCD) has published minimum reporting guidelines.1 This study assessed whether DXA reports for patients attending an academic teaching hospital adhere to ISCD reporting standards and to identify any differences related to patient factors or imaging service.

Methods: Patients aged ≥18 years, attending outpatient clinics between 01/01/2018 and 31/12/2019, with a DXA report, were included. DXA reports were reviewed for adherence to ISCD guidelines, with each criteria scored as one point, and the score converted to a percentage. Statistical analysis included frequencies and Poisson regression analysis to compare DXA report performance between imaging services.

Results: Of 459 DXA scans included, 214 were performed internally at our institution and 245 performed externally at 23 imaging services. Mean (SD) patient age was 60 (16.3) years; 75.8% were female. The overall median (IQR) DXA report score was 57.1% (39.5). ISCD criteria with the lowest scores were ‘recommendation and timing of future DXA scans’ (included in 1.1% of reports) and ‘investigation for secondary causes of osteoporosis’ (included in 1.2% of reports). Reports performed internally had significantly higher scores than those performed externally, after adjusting for age, sex, indication and type of scan (IRR 1.83, 95% CI 1.77, 1.89). Baseline DXA reports had higher scores than repeat DXA scans (IRR 1.05, 95% CI 1.02, 1.09, p<0.001), and, among external imaging services, rural services had higher scores than metropolitan services (IRR 1.16, 95% CI 1.06, 1.28, p=0.001).

Conclusion: The largest comprehensive evaluation of DXA reports, this study highlights significant deficiencies and variation in report standards between imaging services. This has potential implications for osteoporosis diagnosis and management.

References

  1. The International Society for Clinical Densitometry. 2019 ISCD official positions - adult 2019 [Available from: https://www.iscd.org/official-positions/2019-iscd-official-positions-adult/.