Study highlights delay in detection and treatment of osteoporosis

A new perspective article published in the Lancet Diabetes & Endocrinology highlighted that detection and treatment of osteoporosis lag behind other diseases, resulting in significant morbidity, mortality and economic costs.

Over the past 30 years, tremendous progress has been made in the ability to diagnose osteoporosis, a disease that was once thought to be an inevitable consequence of aging that weakens bones and can reduce mobility, cause pain and increase mortality. Unfortunately, despite these advances, the use of dual-energy x-ray absorptiometry (DXA) and fracture risk assessments – tests that can accurately diagnose osteoporosis and determine the likelihood of having a hip fracture or another bone – is in decline. According to the perspective, DXA use among women 65 and older dropped to 11.3% in 2014 from 13.2% five years earlier. The drop coincided with a 70% reduction in Medicare reimbursements for in-office scans.

Titled “Osteoporosis in the United States: Prevention and Unmet Need,” the review pointed out that many at-risk patients are not advised to take preventive medications and may be too afraid to take them. The failures of primary prevention of osteoporosis are compounded by inadequate post-fracture follow-up care. The review noted that following a fracture, patients are not treated with effective drugs, which contrasts with the treatment of patients after a heart attack. Of patients with acute myocardial infarction (AMI), 96% received standard drugs, while only 30% of women aged 66 or older received standard drugs to treat osteoporosis within 12 months following their fracture.

Additionally, studies have shown significantly lower screening with bone density tests and treatment in non-Hispanic black women, with estimates of a disparity from non-Hispanic white women of up to 20%. This disparity is also present in post-fracture diagnosis and treatment. Our review highlighted some myths about patients with osteoporosis. Osteoporosis is thought to affect non-Hispanic white and Asian women, and this may be why post-fracture screening, prevention, and treatment for non-Hispanic black women is so inferior. »

Douglas P. Kiel, MD, MPH, Co-Author, Director, Center for Musculoskeletal Research and Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Professor of Medicine, Harvard Medical School

According to the perspective, reducing Medicare reimbursement for DXA has also disenfranchised rural communities. “Understanding the impact of access to osteoporosis screening and treatment will help the country reduce disparities in care,” added Dr. Kiel. “Major gaps remain in how the United States serves patients with this important age-related chronic disease, and it is clear that we need to address the disparity and access to standards of care. »

Another difficult factor is that there are currently no clear options for the primary prevention of osteoporosis. Estrogen had been widely used in young postmenopausal women with risk factors for osteoporosis, but a Women’s Health Initiative study raised concerns about its long-term safety, leaving a gap in options. treatment.

Mayo Clinic and the American Society for Bone and Mineral Research at the University of Alabama collaborated on this perspective article.

Other authors included: Sundeep Khosla, MD, Chief, Osteoporosis and Bone Biology Laboratory, Mayo Clinic Kogod Center on Aging; Ann L Elderkin, PA, former executive director, American Society for Bone and Mineral Research (ASBMR); and Nicole C Wright, Ph.D., MPH, assistant professor in the Department of Epidemiology at the University of Alabama at Birmingham (UAB).

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