US study shows millions with osteoporosis go undiagnosed

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US study shows millions with osteoporosis go undiagnosed

Jul 28, 2004 Mann

Palo Alto, CA - Despite recent gains in the awareness and treatment of

osteoporosis, millions of Americans still remain undiagnosed and untreated

until they suffer a fracture, according to new research in the July 26, 2004

issue of the Archives of Internal Medicine [1].

The new study tracked frequency of osteoporosis visits and prescription

patterns for office-based US physicians from the IMS National Disease and

Therapeutic Index from 1988 through 2003. Although osteoporosis-related

visits had remained stable in previous years, they increased nearly 5-fold

between 1994 and 2003, from 1.3 million to 6.3 million visits. The increase

mirrored the availability of oral bisphosphonates and the selective

estrogen-receptor modulator raloxifene (Evista, Lilly). In fact, the

percentage of osteoporosis visits in which a medication was prescribed

increased from 82% in 1988 to 97% in 2003.

Even with these gains, researchers estimate that fewer than half of the

people with osteoporosis have been recognized as such.

More screening needed

" Orthopedists often participate in the diagnosis of osteoporosis because it

comes to their attention with unexpected fractures, " lead author Dr Randall

Stafford (Stanford Prevention Research Center, Palo Alto, CA) tells

rheumawire. " What this research suggests is that there needs to be more

attention to screening. Orthopedists have probably had a larger role in the

past than they should in the future. Screening needs to be done regularly by

primary-care physicians. We would hope that we would move away from a

situation where a patient is being diagnosed with osteoporosis after a

fracture and moving on to the direction of better screening. "

Orthopedists have probably had a larger role in the past than they

should in the future. Screening needs to be done regularly by primary-care

physicians.

In 2001, the direct medical costs of osteoporosis were about $17 billion.

Despite this, it was not until 2002 that the US Preventive Services Task

Force began recommending that all women over age 65 be screened for low bone

density.

Calcium being ignored?

One cause for concern is that as prescriptions for newer antiosteoporosis

drugs have increased, the use of calcium supplements has decreased. Before

1994, calcium and estrogens were the treatment of choice for osteoporosis,

with lesser roles played by calcitonin and bisphosphonates. From 1994 to

2003, however, treatment with bisphosphonates jumped from 14% to 73%, the

percentage of doctor visits where raloxifene was prescribed increased from

0% to 12%, and treatment of osteoporosis patients with calcium supplements

dropped from 43% to 24%.

" This is very surprising, " Stafford says. " In some sense, the situation

where we rely on new medications that are clearly very effective has caused

physicians and the public to neglect several other components of a complete

plan for osteoporosis treatmentwhich includes not only effective drugs but

also calcium, vitamin D, and weight-bearing exercise. In an era where these

new drugs have been given so much attention, physicians and the public may

have neglected those components that are less technological but extremely

important in the total package of osteoporosis treatment. "

Source

1. Stafford RS, Drieling RK, and Hersh AL. National trends in

osteoporosis visits and osteoporosis treatment, 1988-2003. Arch Intern Med

2004; 164:1525-1530.