Currently, in Ontario, and in most other provinces, there is great variation in the way BMD (Bone Mineral Density) test referrals are made. BMD testing measures bone mass, indicating whether someone has osteoporosis or is at risk, and plays an important role in the reduction of morbidity and mortality related to fractures. It is therefore important to standardize BMD requisitions, to ensure appropriate ndividuals get tested for osteoporosis risk.

The Recommended Use Requisition (RUR) for referral for Bone Mineral Density (BMD) testing, a tool developed through the Ontario Osteoporosis Strategy by a team of researchers at Women’s College Hospital, has potential to influence the development and implementation of a standardized requisition for BMD testing.

The RUR has the potential to make the following impacts:

• Increase BMD testing in those at high risk
• Decrease BMD testing in those at low risk
• Increase the accuracy of BMD reports by ensuring that clinical risk factors that modify fracture assessment are included at the time of BMD reporting/fracture risk assessment, by the reading physician.

These impacts will improve the overall quality of osteoporosis and fracture care in Ontario as information gained from a BMD test can guide clinicians and patients in understanding the risk of having an osteoporosis-related fracture, and inform decisions aimed at mitigating these risks.

This RUR has been validated by the Ontario BMD Working Group (a multidisciplinary team of family physicians, radiologists, internists, and scientists) and in relation to the current clinical guidelines for BMD testing, the OHIP Fee Schedule, and recommendations from Choosing Wisely Canada. In recognition of the importance of this initiative, Choosing Wisely Canada has recently partnered with the Ontario Osteoporosis Strategy on the initiative

The RUR form is currently available in PDF format and a version for the PS Suite EMR is under development. The PDF can be downloaded at: www.osteostrategy.on.ca

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