Osteoporosis screening spurs employees to act

Over 90% of at-risk workers change lifestyle

When a screening program can successfully identify a number of at-risk employees, that in itself may be considered a significant step toward improved employee health. But when 92% of the participants identified as at-risk make at least one lifestyle change to prevent a specific disease — in this case, osteoporosis — that’s really a cause for celebration.

That’s exactly what happened with CIGNA Corp.’s osteoporosis screening program, which was initiated in its Philadelphia and Connecticut facilities. The program, provided through a partnership with pharmaceutical giant Merck & Co. Inc., includes an osteoporosis risk assessment and an educational seminar on osteoporosis, with take-home literature. It also provides individual consultation and follow-up with a nurse to discuss treatment and prevention recommendations. Additionally, employees are offered the opportunity to have a bone mineral density scan of their heel.

CIGNA, a leading employee benefit provider, recently reported results of the program through 1999. The company was so encouraged that it expanded the program to Georgia and North Carolina this summer.

Why did employees respond so enthusiastically? "I think we did a pretty good job of communicating the program to employees," notes Catherine Hawkes,CIGNA’s assistant vice president of health management. "We used e-mail messages, literature tables, and encouraged people to take a pretest prior to the risk assessment. This piqued their interest. Then, when they had a heel scan, they got the results right there from a nurse or a physician, who interpreted those results for the employee. People with abnormal results were then referred to their primary care provider."

CIGNA also worked closely with their health plan, sending a "heads-up" letter to primary care physicians, along with information about osteoporosis. "That’s a very important thing to do," says Hawkes. "Too often, employees are given test results, they run to their doctor, and the doctor is resentful he didn’t order the test himself. This way, the doctor has the test results in hand and can come up with a plan for his patient. That’s why 92% of those employees with abnormal results followed through with lifestyle changes." The study also showed that 62% of those participants with abnormal screening results went on to discuss them with a primary care physician, and 38% began taking medication to reduce their risk of developing the disease.

A demographic imperative

Hawkes notes that CIGNA’s demographics drove the program. "The vast majority of individuals with osteoporosis are women," she says, "so with almost 80% of our employees being females with an average age of 37, it was a perfect group to educate about how to prevent bone loss later in life." Hawkes adds, however, that osteoporosis does strike both men and women, and the program was open to all employees, regardless of gender. "And we did have seven men who had osteopenia [reduced bone density]," she reports.

Overall, the screening program found 16% of the participants had osteopenia, while 2% had osteoporosis. What is the difference? "Osteopenia is a better result," explains Hawkes. "It just means that compared to healthy bone, yours have less density. But osteoporotic bone would look like Swiss cheese."

It’s very important, she notes, for individuals in the group with osteopenia to begin to take all the preventive measures available to them. "This is a real wake-up call, Wow, my bones not as strong as my neighbors’, and I need to look at my calcium intake, initiating weight-bearing exercises, looking at my alcohol intake, and quit smoking,’" Hawkes asserts. "Chances are very likely that if I continue with the same lifestyle, I will develop osteoporosis."

Risk levels can mislead

One of the more interesting findings in the study was that low-risk individuals were not necessarily immune to loss of bone density. In fact, 43% of the osteopenia cases and 14% of the osteoporosis cases were initially categorized as low risk. "Some of that is related to medical history," notes Hawkes. "Asthmatics may have taken steroids, an other individuals may have had cancer treatment. Some women who had early menopause and early hysterectomies may never have been treated with estrogen. Some women might have had eating disorders resulting in very low body weight; others, such as ultra’ athletes and ballerinas, may suffer from irregular periods. The prescreening risk assessment might not have gotten at those issues."

What about high-risk individuals? Can osteoporosis still be prevented? "That depends," says Hawkes. "Those people then would be counseled by their primary care physician. They will look closely at their personal and family histories, and they might order a dexa scan — the next level of testing. Our results could be reflecting a false positive, but the dexa scan is a diagnostic screening. This is the Cadillac of bone density screening; it measures bone in the back and the hip. It’s much more precise. Based on those results, there could be some medications recommended."

Many shared with family

Another important finding of the study was that 75% of program participants shared some of the educational materials with family members. "That’s the generational impact public health officials are always talking about," Hawkes observes. "Education is spread by people talking with their daughters, their sisters, and their neighbors."

[For more information, contact: Catherine Hawkes, CIGNA Corp., One Liberty Place, 1650 Market St., Philadelphia, PA 19192-1550. Telephone: (215) 761-1000. Web site: www.cigna.com.]