Recommended Use Requisition (RUR) for BMD Testing

The Recommended Use Requisition (RUR) for referral for bone mineral density (BMD) testing was developed through the Ontario Osteoporosis Strategy by a team of researchers at Women’s College Hospital. It 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 our team.

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. BMD testing plays an important role in the reduction of morbidity and mortality related to fractures, and it is therefore important that the appropriate people are being tested.

Currently, in Ontario, and in most other provinces, there is great variation in the way BMD referrals are made. Thus, this initiative has potential to influence the development and implementation of a standardized requisition for BMD testing.

The form is now available as a PDF and PSS custom form for EMRs.