Department of Family Medicine and Obstetrics & Gynecology, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.
Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.
J Gen Intern Med. 2017 Oct;32(10):1090-1096. doi: 10.1007/s11606-017-4094-y. Epub 2017 Jun 20.
Existing guidelines for repeat screening and treatment monitoring intervals regarding the use of dual-energy x-ray absorptiometry (DXA) scans are conflicting or lacking. The Choosing Wisely campaign recommends against repeating DXA scans within 2 years of initial screening. It is unclear how frequently physicians order repeat scans and what clinical factors contribute to their use.
To estimate cumulative incidence and predictors of repeat DXA for screening or treatment monitoring in a regional health system.
Retrospective longitudinal cohort study PARTICIPANTS: A total of 5992 women aged 40-84 years who received initial DXA screening from 2006 to 2011 within a regional health system in Sacramento, CA.
Two- and five-year cumulative incidence and hazard rations (HR) of repeat DXA by initial screening result (classified into three groups: low or high risk of progression to osteoporosis, or osteoporosis) and whether women were prescribed osteoporosis drugs after initial DXA.
Among women not treated after initial DXA, 2-year cumulative incidence for low-risk, high-risk, and osteoporotic women was 8.0%, 13.8%, and 19.6%, respectively, increasing to 42.9%, 60.4%, and 57.4% by 5 years after initial screening. For treated women, median time to repeat DXA was over 3 years for all groups. Relative to women with low-risk initial DXA, high-risk initial DXA significantly predicted repeat screening for untreated women [adjusted HR 1.67 (95% CI 1.40-2.00)] but not within the treated group [HR 1.09 (95% CI 0.91-1.30)].
Repeat DXA screening was common in women both at low and high risk of progression to osteoporosis, with a substantial proportion of women receiving repeat scans within 2 years of initial screening. Conversely, only 60% of those at high-risk of progression to osteoporosis were re-screened within 5 years. Interventions are needed to help clinicians make higher-value decisions regarding repeat use of DXA scans.
现有的关于双能 X 射线吸收法（DXA）扫描的重复筛查和治疗监测间隔的指南相互矛盾或缺乏。明智选择运动建议不要在初次筛查后 2 年内重复 DXA 扫描。目前尚不清楚医生多久会再次安排 DXA 扫描，以及哪些临床因素会影响其使用。
在一个区域卫生系统中，估计重复 DXA 筛查或治疗监测的累积发生率和预测因素。
回顾性纵向队列研究
总共 5992 名年龄在 40-84 岁之间的女性，她们在加利福尼亚州萨克拉门托的一个区域卫生系统中于 2006 年至 2011 年期间接受了初次 DXA 筛查。
根据初始筛查结果（分为三组：低或高进展为骨质疏松症风险，或骨质疏松症）和女性在初次 DXA 后是否开具骨质疏松症药物，计算 2 年和 5 年重复 DXA 的累积发生率和危险比（HR）。
在初次 DXA 后未接受治疗的女性中，低危、高危和骨质疏松症女性的 2 年累积发生率分别为 8.0%、13.8%和 19.6%，初次筛查后 5 年分别增加至 42.9%、60.4%和 57.4%。对于接受治疗的女性，所有组别的重复 DXA 中位时间均超过 3 年。与低风险初始 DXA 的女性相比，高风险初始 DXA 显著预测未治疗女性的重复筛查[调整后的 HR 1.67（95%CI 1.40-2.00）]，但在治疗组中没有预测作用[HR 1.09（95%CI 0.91-1.30）]。
在低和高进展为骨质疏松症风险的女性中，重复 DXA 筛查均很常见，其中很大一部分女性在初次筛查后 2 年内接受了重复扫描。相反，只有 60%的高进展为骨质疏松症风险的女性在 5 年内再次筛查。需要采取干预措施，帮助临床医生在重复使用 DXA 扫描方面做出更有价值的决策。
