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DEXA demand to soar

By Nerys Hairon

Demand for DEXA scans will soar nearly 20-fold if GPs implement NICE guidance on osteoporosis, a new analysis warns.

The guidance on the secondary prevention of osteoporotic fractures would also send prescribing of bisphosphonates spiralling by more than 200 per cent, the audit found.

The researchers, who presented their analysis at the National Osteoporosis Society conference in Harrogate this week, said the increases would have 'huge cost implications' for primary care organisations.

'Whether this will be cost-

effective remains to be seen,' they added.

NOS figures show average waiting times for a DEXA scan stood at 17 weeks in 2005, ranging from two weeks at some centres to 69 weeks at others, although the society said there had since been a funding boost for scanning facilities.

The researchers audited a representative practice population of 11,472 patients in Pembrokeshire to determine likely implications of implementing the 2005 NICE guidelines.

They identified 40 patients with osteoporotic fractures, of whom 18 were women aged 45 to 74, who would qualify for a DEXA scan before treatment under the guidance. Only one had received a scan. And 19 of the 40 were not on bisphosphonates or calcium supplements.

A second audit presented at the conference, of elderly hospital inpatients in Walsall, found that only 2 per cent of those who met Royal College of Physicians indications for a DEXA scan had received one.

Dr Salah Abusin, leader of the first study and a senior house officer in Cardiff, said: 'If guidelines say this is best practice the Department of Health should ensure provision of DEXA scans and cover prescribing costs.'

Dr Roger Burns, a GP in Haverfordwest, Pembrokeshire, whose practice undertook the audit, said: 'It just shows how things are brought in without working out the implications.'

Dr Pam Brown, a member of the primary care forum at the NOS and a GP in Swansea, said: 'We must be aware current DEXA use and treatment represent poor care. Bisphosphonate costs will inevitably rise, since only 10-15 per cent of patients are being treated.'

Case study

Auditing against NICE guidance can lead to a dramatic increase

in prescribing, Dr Arvind Mohan found. He assessed osteoporosis care against the guidance while working as a GP registrar at a practice in Horsham, West Sussex.

Only six of 27 patients over 75 with a history of fracture were on osteoporosis treatment. A second data audit three months later found the number increased to 22.

The researchers, who presented their results at the conference, said the use of computer-generated reminders could help GPs keep track of those eligible for treatment under NICE.

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