Background Osteoporotic fractures are a costly consequence of osteoporosis and lead to significant morbidity and mortality. The World Health Organization (WHO) criteria define osteoporosis as a T-score on a duel x-ray absorptiometry (DXA) scan of ≤ −2.5. The less stringent National Osteoporosis Foundation (NOF) guidelines recommend treatment for a T-score ≤ −2.0, ≤ −1.5 in women with risk factors or any T-score with a history of hip or vertebral fractures. Existing data clearly show that woman are underscreened and undertreated. The purpose of this study is to assess the treatment rate of osteoporosis as verified by DXA scan in selected teaching clinics.
Methods This is a multicenter cohort prospective quality improvement study of patients presenting to outpatient clinics affiliated with 13 US medical centers. Women age 65 or older were administered a 77-item survey regarding their health, attitudes and beliefs, osteoporosis knowledge, and demographics. A chart review was completed for documentation of osteoporosis screening and treatment. Following patient and physician educational interventions, a follow-up chart review will be completed. Preliminary data were analyzed using Stata with bivariate analysis.
Results Preliminary results are presented for 137 patients from six sites. Of these, 53 (43.8%) had evidence of a DXA scan in their chart, and 18 or 33.96% of women with a DXA scan met the criteria for osteoporosis by the most conservative definition (T-score ≤ −2.5). Only 10 (55.6%) of the 18 women had documentation of treatment with a bisphosphonate, SERM, Forteo, or calcitonin. Survey results were consistent with the chart review.
Conclusions Initial data show that women age 65 or older with a diagnosis of osteoporosis by DXA scan are consistently undertreated in this study population. Self-reported and chart-documented treatment rates are similar. These data underestimate the number of women who meet treatment criteria using the NOF guidelines. A possible reason for the low treatment rate is that patients or providers view an abnormal DXA scan as a less significant result than an abnormal result on other screening modalities. Alternately, individuals may perceive that treatment is not indicated if symptomatic manifestations are not present. Concern about cost or dosing compliance of certain therapies may play a role. Further analysis of characteristics and views regarding screening and treatment may identify target populations that would benefit most from osteoporosis education and interventions.
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