Trends and Disparities in Osteoporosis Screening Among Women in the United States, 2008-2014

Gillespie, Catherine W.; Morin, Pamela E.

doi:10.1016/j.amjmed.2016.10.018

Cited by 107 publications

(86 citation statements)

References 15 publications

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“…Asian populations are prone to have a higher exposure to Cd and Pb (Awata, Linder, Mitchell, & Delclos, ; McKelvey et al, ) and are more vulnerable to have low BMD than other racial groups (Gillespie & Morin, ) regardless of socioeconomic status. Human studies about co‐exposure to Cd and Pb in Chinese adult populations are seldom reported, paritcularly for southwestern areas.…”

Section: Introductionmentioning

confidence: 99%

“…Asian populations are prone to have a higher exposure to Cd and Pb (Awata, Linder, Mitchell, & Delclos, 2017;McKelvey et al, 2007) and are more vulnerable to have low BMD than other racial groups (Gillespie & Morin, 2017) The investigation area of this study is a part of the Chengdu Plain in Sichuan Province, located in southwestern China. The Cd and Pb pollution of soils have been reported in the chosen polluted area (Chen, Teng, Lu, Wang, & Wang, 2015;Zhan, Li, Yu, & Zhang, 2018), and dietary Cd exposure was relatively high owing to homegrown food in adults (Huo et al, 2018).…”

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confidence: 99%

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Co‐exposure of cadmium and lead on bone health in a southwestern Chinese population aged 40‐75 years

Yan

et al. 2019

J of Applied Toxicology

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Both cadmium (Cd) and lead (Pb) are associated with bone health, but studies exploring the effects of Cd and Pb co‐exposure on bone health are rare. This study aimed to assess the interactive effects of Cd and Pb co‐exposure on bone health. In total, 799 participants, living in the targeted areas (located in southwestern China) for more than 15 years, aged 40‐75 years, and subsisted on homegrown rice and vegetables were investigated. Cd and Pb levels in urine and blood samples, as well as bone mineral density, T‐ and Z‐score were determined. After being adjusted for covariates, the T‐score was negatively correlated with blood Pb in men (P < .05); for women and non‐smoking women, the T‐score was negatively correlated with urinary Pb (P < .05). Moreover, after being adjusted for covariates, the Z‐score was negatively correlated with urinary Pb in non‐smoking women (P < .05). No positive association of prevalence of osteoporosis with Cd and Pb exposure was found. However, at an additive scale, positive interactions of urinary Cd and Pb on the prevalence of osteoporosis for women and non‐smoking women, and the same interactions to blood Cd and Pb for men were found. There was also a positive interaction of urinary Cd and Pb for women at a multiplicative scale. This study suggests Cd and Pb exposure could exert detrimental effects on bone health, with possible underlying interactions. Nevertheless, more studies are needed to explore the interactive effects of heavy metal co‐exposure.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Co‐exposure of cadmium and lead on bone health in a southwestern Chinese population aged 40‐75 years

Yan

et al. 2019

J of Applied Toxicology

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“…For example, studies have shown that fewer than 30% of women over the age of 65 years with a known diagnosis of osteoporosis receive treatment, and only 23% of women aged 50 years and older who sustain an osteoporotic fracture receive treatment within the first year after fracture . A recent large study that analyzed insurance claims data of more than 1.5 million US women aged 50 years and older found that fewer than 1 in 4 had osteoporosis screening within the most recent 2‐year continuous enrollment period . Osteoporosis screening and treatment rates are even lower for older men in the US .…”

Section: Introductionmentioning

confidence: 99%

“…(15,16) A recent large study that analyzed insurance claims data of more than 1.5 million US women aged 50 years and older found that fewer than 1 in 4 had osteoporosis screening within the most recent 2-year continuous enrollment period. (17) Osteoporosis screening and treatment rates are even lower for older men in the US. (18)(19)(20) One study found that fewer than 20% of men aged 70 to 75 years received screening with dual-energy X-ray absorptiometry (DXA).…”

Section: Introductionmentioning

confidence: 99%

How Can We Improve Osteoporosis Care? A Systematic Review and Meta-Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis

Nayak

Greenspan

2018

Journal of Bone and Mineral Research

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Although osteoporosis affects 10 million people in the United States, screening and treatment rates remain low. We performed a systematic review and meta-analysis of the efficacy of quality improvement strategies to improve osteoporosis screening (bone mineral density [BMD]/dual-energy X-ray absorptiometry [DXA] testing) and/or treatment (pharmacotherapy) initiation rates. We developed broad literature search strategies for PubMed, Embase, and Cochrane Library databases, and applied inclusion/exclusion criteria to select relevant studies. Random-effects meta-analyses were performed for outcomes of BMD/DXA testing and/or osteoporosis treatment. Forty-three randomized clinical studies met inclusion criteria. For increasing BMD/DXA testing in patients with recent or prior fracture, meta-analyses demonstrated several efficacious strategies, including orthopedic surgeon or fracture clinic initiation of osteoporosis evaluation or management (risk difference 44%, 95% confidence interval [CI] 26%-63%), fracture liaison service/case management (risk difference 43%, 95% CI 23%-64%), multifaceted interventions targeting providers and patients (risk difference 24%, 95% CI 15%-32%), and patient education and/or activation (risk difference 16%, 95% CI 6%-26%). For increasing osteoporosis treatment in patients with recent or prior fracture, meta-analyses demonstrated significant efficacy for interventions of fracture liaison service/case management (risk difference 20%, 95% CI 1%-40%) and multifaceted interventions targeting providers and patients (risk difference 12%, 95% CI 6%-17%). The only quality improvement strategy for which meta-analysis findings demonstrated significant improvement of osteoporosis care for patient populations including individuals without prior fracture was patient self-scheduling of DXA plus education, for increasing the outcome of BMD testing (risk difference 13%, 95% CI 7%-18%). The meta-analyses findings were limited by small number of studies in each analysis; high between-study heterogeneity; sensitivity to removal of individual studies; and unclear risk of bias of included studies. Despite the limitations of the current body of evidence, our findings indicate there are several strategies that appear worthwhile to enact to try to improve osteoporosis screening and/or treatment rates. © 2018 American Society for Bone and Mineral Research.

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“…However, the actual utilization of FRAX is poor, with the USA performing 11,807 calculations per 1 million people over the age of 50 [88]. Furthermore, the utilization of any screening method for osteoporosis is less than 27% for patients ages 65-79, with percentages worsening with both younger and older patient populations [89]. Utilization of prescreening methods in a clinical setting could easily increase among physicians, with many other questionnaires and tests available.…”

Section: Denosumabmentioning

confidence: 99%

Osteoporosis: a discussion on the past 5 years

Schweser

Crist

2017

Curr Rev Musculoskelet Med

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Purpose of the review The purposes of this study are to examine the literature within the past 5 years regarding osteoporosis and offer a discussion on new topics and controversies. -Ultrasound may be cost-effective for diagnosis. Summary Understanding of osteoporosis has come a long way in the medical community, but the translation to the lay community has lagged behind. Patients often take a laissezfaire attitude toward osteoporosis that can affect compliance. Information read by patients often focuses on complications, such as atypical femur fractures and myocardial infarctions. It is essential for providers to be able to discuss these issues with patients. Newer medications and more cost-effective diagnostic tests exist, but availability may be limited. FLS are effective, but the most cost-effective model for therapy still eludes us. Areas for further investigation include FLS models, the effectiveness of vitamin supplementation, and more ubiquitous and cost-effective diagnostic tools.

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Trends and Disparities in Osteoporosis Screening Among Women in the United States, 2008-2014

Abstract: Despite significant changes in utilization of osteoporosis screening among women ages 50-64 and 80+, in line with national recommendations, tremendous deficiencies among women 65+ remain.

Cited by 107 publications

References 15 publications

Co‐exposure of cadmium and lead on bone health in a southwestern Chinese population aged 40‐75 years

Co‐exposure of cadmium and lead on bone health in a southwestern Chinese population aged 40‐75 years

How Can We Improve Osteoporosis Care? A Systematic Review and Meta-Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis

Osteoporosis: a discussion on the past 5 years

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