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Entries in Bone Density (3)

Thursday
Apr052012

Doctors: Extra Tests Not Key to Best Patient Care

Comstock/Thinkstock(NEW YORK) -- In an effort to end medical over-testing, nine major medical professional organizations have banded together to try to change the way doctors use tests and procedures once considered fairly routine.

The campaign, Choosing Wisely, a joint effort led by the American Board of Internal Medicine Foundation and Consumer Reports, released a list of 45 common tests and procedures it hopes will be more carefully prescribed and performed.

The campaign is a frank attempt by a wide consortium of medical groups to address what many characterize as rampant, wasteful procedures and spending in the U.S. health care system.

"The distinction to be drawn is between 'care' and 'tests,'" said Dr. Thoralf Sundt, chief of cardiac surgery at Massachusetts General Hospital.  "Doing tests is not the same as providing care in all instances."

Several of the over-used tests called out by the specialty organizations are procedures that have long been considered routine or harmless by many.  Staples such as cardiac stress tests or chest x-rays before minor surgery got the thumbs down from several of the groups.

Some of the recommendations are not radically different from what other groups have been saying for years.  Several guidelines, such as those recommending against Pap tests for women under age 21 or bone density scans for women before age 65, have recently been publicized by the U.S. Preventive Services Task Force, the government body charged with reviewing and recommending health care processes.

But many doctors say that the endorsement of less testing by the heavyweight medical specialty groups may just resonate with more physicians and could alter what has been routine practice.

"It is important because it signals from physician leadership that there is waste in the system that should and could be reduced," said Dr. Harlan Krumholz, professor of investigative medicine and public health at Yale University School of Medicine.  "And it should be just the beginning of a movement."

Many doctors do such screenings and procedures for a variety of reasons other than patient care, doctors say.  Often the reason is simple: a given test or procedure is what the doctor has always done.

Others feel that ordering a barrage of tests will yield the source of a patient's problem, or will reveal an unknown danger.  Other doctors use tests defensively, out of fear that not ordering a test could look like negligence and prompt a lawsuit.

"After a while, getting a CT for a headache or fainting spell even without any neurologic deficits or a stress test for asymptomatic patients becomes the de facto 'standard of care' and physicians are afraid to miss something lest they be sued," said Dr. John Messmer, associate professor of family and community medicine at Penn State College of Medicine.

But experts say it's time to drop this just-in-case mindset.

Reframing conventional medical thinking about testing would likely be a money-saver for the U.S. healthcare system. Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone.

Copyright 2012 ABC News Radio

Wednesday
Apr042012

Five Medical Tests You May Not Need

Keith Brofsky/Thinkstock(NEW YORK) -- A routine visit to the doctor's office can bring up a laundry list of medical tests, all designed to screen for one serious disease or another.  But according to a new report from leading physician groups, a large number of medical tests and procedures billed as routine are largely unnecessary.

For many patients and doctors, it's easy to adopt the notion that if a little screening is good, more of it is better, "just to be sure" nothing is wrong.  But that approach is costly, both in terms of health care dollars spent and the potential risks of the screenings.

"There's no medical treatment or test that is 100 percent without risk," said Dr. Christine Cassel, president and chief executive officer of the American Board of Internal Medicine Foundation.  "Things that you might think are routine actually should not be done because they expose patients to risk."

To help patients parse through the barrage of medical procedures, the ABIM Foundation and Consumer Reports have created the Choosing Wisely project, a campaign that asked nine physician groups to identify five tests or procedures in their fields that are over used or unnecessary.

Cassel said the project is designed to give patients as much information as doctors have about screening, as well as to rein in health care costs.

The full list was published on Wednesday, but here's a look at five common tests you may not need:

Cardiac Stress Test


Cardiac stress tests were once considered a staple of routine check-ups.  Also called the treadmill test or an exercise EKG, doctors often use it to determine if a patient has blocked arteries.  The U.S. Preventive Services Task Force has long recommended that people at low risk for cardiovascular disease and with no symptoms of heart trouble don't need an annual stress test.  But a 2010 Consumer Reports survey of 8,000 people ages 40 to 60 found that 44 percent of low-risk people with no symptoms had been screened.

According to the American College of Cardiology, stress tests should only be performed on patients who have peripheral artery disease, diabetics over age 40 and people who have an increased risk of coronary artery disease.

Chest X-rays Before Minor Surgery

For many years, chest x-rays were another nuts-and-bolts part of hospital care.  But the test is going by the wayside.  The American College of Radiology said for most patients undergoing outpatient procedures, the tests are unnecessary. 

Some people should get a chest x-ray before going under the knife, such as those with a history of heart problems, lung disease or cancer.  For others with a normal physical exam, the ACR said the test leads to a change in patient care in only two percent of cases.

Imaging Tests for Lower Back Pain

According to the American Academy of Family Physicians, lower back pain is the fifth most common reason for all visits to the doctor's office.  But unless a patient has certain red flags of a deeper physical problem, such as spinal abnormalities or neurological problems, the AAFP and the American College of Physicians say doctors shouldn't use MRIs, CT scans or other imaging to investigate lower back pain.

Frequent Colon Cancer Screenings

Colonoscopies, perhaps the most unloved cancer screening, are a necessary aspect of health care after age 50.  A recent study found that having precancerous growths spotted on colonoscopies removed cut the death rate from colon cancer by 53 percent. 

Most major medical groups recommend that people over 50 get a colonoscopy every 10 years.  However, the key is moderation.  According to the American Gastroenterological Association, most adults who are at an average risk of colon cancer and who get a clean bill of health from a colonoscopy don't need another one for the next decade -- good news for health care pocketbooks, since the test costs an average of $1,050.

Bone Density Scans

Osteoporosis becomes a real risk for people, particularly women, with increasing age.  The National Institutes of Health estimates that one in five women over age 50 has osteoporosis.  But patients may want to ask their doctors how often they need a bone density scan to screen for signs of the disease.

The American Academy of Family Physicians echoes the U.S. Preventive Services Task Force in recommending that only women over age 65 get a bone mineral density test, called dual-energy x-ray absorptiometry, or a DEXA scan.  The AAFP also recommends the test for men age 70 and older, although the USPSTF said there is insufficient evidence to balance the risks and benefits of screening men for osteoporosis. 

The test costs more than $100, and unless a woman under age 65 has additional risk factors, such as smoking, an eating disorder or previous broken bones, doctors say the scan is unnecessary.

Copyright 2012 ABC News Radio

Monday
Feb062012

Hormone Therapy Raises Women's Risk for Bone Loss

Jupiterimages/Thinkstock(TORONTO) -- A class of medication used to prevent and treat breast cancer in post-menopausal women may boost the risk of bone loss, according to a new study published Monday in the journal Lancet Oncology.

The medications, called aromatase inhibitors, are used as part of hormone therapy to stop estrogen production in post-menopausal women. Research suggests the class of medications can stop tumor growth and prevent recurrence. More recent studies suggest it can reduce a patient's chance of ever getting the getting breast cancer.

But the new study found healthy post-menopausal women who took 25 mg of a type of aromatase inhibitor called exemestane daily for two years experienced bone loss in their wrists and ankles.

Bone density is typically measured in doctors' offices by a standard bone density test. But the women enrolled in the study, who were, on average, 60 years old, were periodically monitored using both a standard bone density test and a CT scan.

This study is the first to use computed tomography (CT) scans to take a detailed look at the exact type of bone loss experienced by women who take aromatase inhibitors. The CT scan offered a more detailed three-dimensional look at the bone structure compared to the standard bone density scan. This helped researchers examine the outer structure of the bone separately from the inner meshwork.

"We know the bone structure matters in terms of strength," said Dr. Angela Cheung, director of the osteoporosis program at University Health Network in Toronto and lead author of the study.

In this case, the detailed look allowed researchers to see exactly how much bone loss the women experienced.

Researchers followed 351 women with no history of osteoporosis for two years, and found an eight-percent decrease in thickness and area in the outer shell of the bone -- called the cortical bone among the women taking exemestane, also known by the brand name Aromasin -- compared to only a one-percent loss in the placebo group.

The majority of fractures in older women are due to cortical bone loss, according to Jane Cauley, a professor in the Department of Epidemiology at the University of Pittsburgh, who wrote an accompanying editorial published in Lancet Oncology. The findings from the CT study, she wrote, suggest that the negative side effects of aromatase inhibitors on bone health are "substantially underestimated."

The study also found that the medication worsened age-related bone loss even for those who took adequate supplements of vitamin D and calcium, which are prescribed to prevent bone loss.

Cheung said the benefit of CT scans uncovered in this study does not indicate that the scans should become a routine form of bone testing, due to high cost, and because CT exposes the patient to radiation.

While low bone mass offers clues to a woman's risk of bone fracture or even osteoporosis, this study was too small and did not follow the women long enough to see whether either condition developed. Researchers now plan to follow these study participants for another five years.

Cheung said that the findings should not turn women away from taking aromatase inhibitors like exemestane.

"For people thinking of prevention for breast cancer, they need to weigh the risk and benefits," said Cheung. "For some, it's just a mild degree of bone loss and for others maybe not."

Many women on aromatase inhibitors are also prescribed bone-strengthening medications like bisphosphonates, said Lillie Shockney, administrative director at Johns Hopkins Breast Clinical Programs. But recent findings suggest that even bisphosphonates can raise a woman's risk of femur fractures.

"It is important for the primary care doctor and the medical oncologist to discuss this before automatically doing so (prescribing bisphosphonates), as these bone-building agents are not side-effect free either," said Shockney.

Most importantly, the way to prevent bone loss is simple: women need to stay active.

"Brisk walking several times a day or hopping on a treadmill is an effective way to keep bones strong," said Shockney. "Bone density should be reassessed periodically while on hormonal therapy and beyond."

Copyright 2012 ABC News Radio







ABC News Radio