Osteoporosis

In the United States today, 10 million people have osteoporosis, and another 18 million have low bone mass, placing them at risk for this condition. Women are four times more likely than men to develop osteoporosis, and one of every two women will have an osteoporosisrelated fracture in her lifetime. Although osteoporosis is the underlying cause of most fractures in older people, it is silent and often goes undetected until a fracture occurs. U.S. health care costs related to osteoporosis are estimated to be $10 to $15 billion per year.

• Better medications for osteoporosis have increased recognition and treatment of the disease.

  More effective and convenient medications for osteoporosis increased osteoporosis-related doctor visits fourfold between 1994 and 2003. The largest increases coincided with market approval of two important osteoporosis drugs-alendronate (September 1995) and raloxifene (December 1997).

• Few postmenopausal women who have suffered a fracture receive medication to prevent further fractures.

  This study of postmenopausal women enrolled in seven HMOs across the country found that only 24 percent of those who had suffered an osteoporosisrelated fracture received drug treatment for osteoporosis within a year following the fracture. Older women were less likely than younger women to receive osteoporosis treatment, even though aging increases the risk of fracture.

• Clinical practice lags behind guidelines for osteoporosis screening and treatment.

  Researchers examined administrative data and medical records for nearly 4,000 women (average age 71) enrolled in an HMO who had been diagnosed with a new fracture from 1998 to 2001. Only about 12 percent of the women had been diagnosed with osteoporosis prior to the fracture, even though nearly 11 percent had conditions or were taking medications that would put them at risk for the condition. Also, 39 percent of the women were already at increased risk of falling due to medical problems (e.g., dementia) or medication (e.g., antidepressants). Physician adherence to guidelines-which call for bone mineral density testing to detect bone loss and, when needed, medication to treat osteoporosis-did not significantly improve from 1998 to 2001.

• Racial disparities found in receipt of osteoporosis screening and management.

  According to this survey of more than 8,000 women aged 50 or older in Alabama, postmenopausal black women are much less likely than their white counterparts to receive bone mineral density testing to detect osteoporosis or to be prescribed medication for osteoporosis. This finding held even among those who had a previous fracture.

• The USPSTF updates osteoporosis screening recommendations.

  The U. S. Preventive Servies Task Force recommends that women 65 and older receive routine screening for osteoporosis to reduce the risk of fracture and spinal abnormalities often associated with the disease. The USPSTF also recommends that routine screening begin at 60 for women identified as high risk because of their weight or estrogen use.

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