Use of bone densitometry by Ontario family physicians

A stratified (urban/rural), computer-generated random sample of 797 Ontario members of the College of Family Physicians of Canada received a self-administered questionnaire by mail. The questionnaire examined current use of bone densitometry, focusing on reasons for its use, factors that limit use, and features of the report that are helpful to the family physician in subsequent patient management. The response rate was 64% (457/711) after excluding 77 physicians who no longer practice family medicine. Ninety-two percent of the physicians used densitometry; of these, 97% ordered the test in the past year. Compared with urban physicians, rural physicians were more likely to 'never use densitometry' (P = 0.04). Rural physicians who reported using densitometry used it less frequently (p = 0.002), were less likely to have local access (p = 0.001), and were less confident in its use (p = 0.004) than their urban counterparts. Risk factors and hormone replacement therapy decision-making were ranked equally as the most frequent reasons for ordering the test, followed by follow-up. Few physicians identified limits to their use of densitometry. Female physicians used densitometry more frequently (p = 0.03) and were more confident in its use (p = 0.02). Features of the bone density report found to be most helpful were the statement of fracture risk, suggestions for further investigation, management and follow-up, and percent reduction in bone density compared with age-matched controls. The use of bone densitometry by Ontario family physicians is consistent with published guidelines. These physicians identified the estimate of fracture risk and suggestions for investigation and management as the most helpful features of the bone density report. This suggests a role for the incorporation of clinical data in bone density reporting.