Predictors of Screening and Treatment of Osteoporosis

Abstract

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...

Factors Associated with Osteoporosis Screening and Recommendations for Osteoporosis Screening in Older Adults

“… 19 , 20 Our observation that osteoporosis screening was more likely in women than men is also consistent with earlier studies. 18 , 21 Our finding that osteoporosis screening was no more likely in white adults than black adults, when adjusting for other osteoporosis risk factors, is different from findings of several previous studies and warrants further study. 18 , 22 …”

Factors associated with diagnosis and treatment of osteoporosis in older adults

“…Multiple previous studies suggest that older individuals are either less likely or no more likely than younger individuals to be treated for osteoporosis [ 18 – 21 ]. A few studies have found that younger patients are less likely to receive pharmacologic treatment for osteoporosis than older patients, but this discrepancy may be secondary to the use of younger age cutoffs to distinguish older from younger patients in these particular studies (e.g., postmenopausal vs premenopausal) [ 22 – 24 ]; our study focused on an older population of individuals, those age 60 and older. Our finding that individuals with prolonged oral steroid use may not be receiving sufficient osteoporosis treatment concurs with that of other studies [ 22 , 25 , 26 ], as does our finding that osteoporosis treatment was more likely in women than men [ 18 , 21 – 23 ].…”

Patterns of Pharmacological Treatment for Osteoporosis Among Patients Qualified for Pharmacotherapy According to the National Osteoporosis Foundation Guidelines

“…3,4 Only 23% of women 55 years or older received pharmacological treatment following a fracture, 5 and nearly half of the women 45 years or older did not initiate pharmacological treatment within 6 months after a bone mineral density (BMD) test confirming osteoporosis or osteopenia. 6 Previous studies have evaluated the patterns of osteoporosis treatment among patients diagnosed with osteoporosis 3,4,[7][8][9][10][11] and estimated the number of individuals who should be considered for osteoporosis treatment. 2,[12][13][14] However, to our knowledge, no studies have assessed the pattern of osteoporosis treatment among those who meet the NOF criteria for pharmacotherapy but may not have been previously diagnosed or aware of their BMD measurement and osteoporosis risk.…”