Initiation of hormone replacement therapy after diagnosis of osteoporosis by bone densitometry

Phillipov, George; Mós, Eduardo do Nascimento; Scinto, S.; Phillips, Patrick J.

doi:10.1016/s0378-5122(97)13537-x

Cited by 3 publications

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“…Table 3 summarizes the main treatments for women and men who reported they had osteoporosis. The findings for women are similar to results obtained in an earlier study (see Table 3) that surveyed the prescribing habits of general practitioners referring patients for routine bone density measurement [8].…”

Section: Resultssupporting

confidence: 89%

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Public Perceptions and Self-Reported Prevalence of Osteoporosis in South Australia

Phillipov

Phillips

Leach³

et al. 1998

Osteoporosis International

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The self-reported prevalence of, and attitudes to and perceptions of, osteoporosis in the South Australian community were assessed using data collected as part of the 1995 South Australian Health Omnibus Survey (household interviews)--a clustered, self-weighting, multistage sample of households in metropolitan and country centers. The self-reported prevalence was 4.8 (95% CI: 3.7-5.8) and 1.4% (95% CI: 0.8-2.0) for women (n = 1531) and men (n = 1485) respectively. For individuals with osteoporosis, calcium was the favored treatment (52%), while 33% of women were on hormone replacement therapy. An appropriate definition of osteoporosis was given by 62% of women and 37% of men. The main risk factors were reported as lack of calcium and age. There was a significant association between knowledge of the definition of osteoporosis and identification of correct risk factors. A high perceived risk of osteoporosis was reported in 23% of women and 7% of men. Osteoporosis risk was assessed as higher in those who did not adopt recognized prevention measures. Perception of risk was not related to the individual's own risk factors. Self-reported prevalence of osteoporosis significantly underestimates the likely true prevalence and general awareness and knowledge is much lower for men than women. The importance of individual risk factors for osteoporosis are not understood by the general community.

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Section: Resultssupporting

confidence: 89%

“…The treatments used by women with osteoporosis are consistent with our previous findings [8] that general practitioners (GPs) prefer to prescribe calcium rather than HRT (Table 3). The 1995 survey reveals that alternative pharmacologic treatments, such as calcitriol or the bisphosphonates, were rarely used.…”

Section: Discussionsupporting

confidence: 88%

Public Perceptions and Self-Reported Prevalence of Osteoporosis in South Australia

Phillipov

Phillips

Leach³

et al. 1998

Osteoporosis International

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“…In clinical practice, the WHO definition of osteoporosis may have important implications for physicians prescribing practices and patient acceptance of therapy [11]. In addition, many managed care organizations, unfortunately, now pay for the cost of treatment of osteoporosis only when a patient's T-score is lower than -2.5.…”

Section: Discussionmentioning

confidence: 99%

How the New Hologic Hip Normal Reference Values Affect the Densitometric Diagnosis of Osteoporosis

Chen

Maricic

Lund

et al. 1998

Osteoporosis International

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In February 1997, Hologic supplied new software to all QDR dual-energy X-ray absorptiometry (DXA) machines replacing the previous femoral normative reference database with the NHANES III normative data. In addition to changing the normative database (and therefore T-scores) for all regions of the hip, the new software has changed the primary region of interest from the femoral neck to the total hip. In the present study we examined how these changes influence the densitometric diagnosis of osteoporosis in a large clinical referral population (n = 2311, mean age 62.7 years). The patients had spine and hip DXA performed at either of two centers using a Hologic QDR-2000 over a 4-year period. T-scores were derived for each patient using both previous and current young normal reference databases. Intraindividual differences in T-scores were calculated. The prevalence of osteoporosis based on the two normative databases and the difference between the prevalence was calculated for each skeletal site. The average paired difference between current and previous T-scores at femoral neck is 0.64, the difference increasing with age. Using the new normative database, the percentage of osteoporotic patients decreases from 49% of all patients at the femoral neck to 28% at the femoral neck and 20% at the total hip. In conclusion, the densitometric diagnosis of osteoporosis will be affected in a significant proportion of women as a result of the implementation of the new hip normative database supplied by Hologic. Whether this will translate into fewer patients being treated remains to be seen.

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“…30 Six studies examined osteoporosis treatment rates after bone densitometry. [42][43][44][45][46][47] In these studies, the proportion of patients receiving treatment was higher among patients with lower bone mineral density measurements. These results suggest that physicians are responding to BMD test results, at least in select populations of patients already undergoing bone densitometry.…”

Section: Treatment Of Osteoporosismentioning

confidence: 99%

Predictors of Screening and Treatment of Osteoporosis

Morris¹,

Cheng²,

Cabral³

et al. 2004

The Endocrinologist

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Evidence exists that many at-risk patients are not screened or receive appropriate therapy for osteoporosis. We reviewed studies of bone mineral density (BMD) testing and osteoporosis therapy to describe predictors associated with screening and treatment of osteoporosis. We performed a structured review, searching MEDLINE and HEALTHStar from 1992 through 2002 using appropriate terms. Two authors examined all retrieved articles, and relevant studies were reviewed with a structured data abstraction form. A total of 277 articles were identified, and 35 met criteria for this review. Of these, 22 described screening patterns and 28 described treatment patterns. Seventy-one percent (25 of 35) of papers examined correlates of either BMD testing or treatment, and half (51%, 18 of 35) used multivariable analyses. Male patient gender and lack of subspecialist care were consistently associated with a higher risk of not receiving BMD testing; male physicians, generalist doctors, and those caring for fewer postmenopausal patients were more likely not to test patients. Younger patients, men, patients without a history of fracture, and those without subspecialist care were at higher risk of not receiving pharmacologic treatments. Six studies that examined treatment frequencies after bone densitometry all found that patients with osteoporosis by bone densitometry were at lower risk of not receiving treatment. Although the current literature is limited by inconsistent inclusion of common covariates and a lack of multivariable analyses, information about patient and physician correlations of osteoporosis management should help inform future quality improvement initiatives. Learning Objectives• Recall reported US rates of screening for osteoporosis by bone mineral density (BMD), and of treatment of bone fracture patients for osteoporosis. • Relate both patient-and physician-associated factors to the likelihood that BMD screening will be carried out. • Identify those factors that predict whether or not an osteoporotic patient will be treated.O steoporosis and resultant fractures are a large and growing public health issue. More than 300,000 hip fractures occur annually in the United States. 1 Screening for osteoporosis, primarily with bone mineral density (BMD) testing, permits prediction of future fractures among white women. [2][3][4] In patients with osteoporosis, there are effective pharmacologic treatments; several widely available therapies reduce future fractures in at-risk populations by 40% to 50%. [5][6][7] However, there is evidence that screening and treatment could not be reaching at-risk populations. Studies of medical records in the United States have reported BMD rates of only 3% to 14% in patients with previous fractures 8,9 and 19% to 23% of glucocorticoid users. 10,11 These rates are similar to those reported in other countries. 12 Treatments for osteoporosis also appear to be underused. Among 14 studies of patients who had sustained a fracture, mean treatment rates were low: calcium supplements were taken by 19...

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Initiation of hormone replacement therapy after diagnosis of osteoporosis by bone densitometry

Cited by 3 publications

References 0 publications

Public Perceptions and Self-Reported Prevalence of Osteoporosis in South Australia

Public Perceptions and Self-Reported Prevalence of Osteoporosis in South Australia

How the New Hologic Hip Normal Reference Values Affect the Densitometric Diagnosis of Osteoporosis

Predictors of Screening and Treatment of Osteoporosis

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