Patterns of osteoporosis management in older women

Approximately 30% of U.S. women 65 years of age and older suffer from osteoporosis. The 300,000 hip fractures that occur annually in the U.S. may account for about 31,000 excess deaths within six months of the fracture. Several medications have been approved for the treatment of osteoporosis in post-menopausal women with low bone density that have been shown to maintain or increase bone density, and/or to reduce the risk of hip and wrist fractures. The evidence to date suggests many women who could benefit from treatment are not receiving it. The first study in this dissertation assessed the patterns of screening, diagnosis and treatment for osteoporosis in a Northeast U.S metropolitan area among women age 50 to 84 that had a history of wrist/forearm or hip fractures. We evaluated the full range of prescription and non-prescription treatments available, as well as change in treatment after the fracture, through a patient survey. Only 42% of our survey respondents were prescribed medication to treat osteoporosis after a hip or wrist fracture. We also found little difference in treatment prevalence based on risk factors for osteoporotic fractures. In our second study, we investigated treatment among older women after bone mineral density exams, and the degree to which bone mineral density and other risk factors cited in treatment guidelines were independently associated with treatment. We found that 69% of subjects with osteoporosis and 45% of those with osteopenia received prescription treatment other than hormone replacement therapy. The presence of at least one additional risk factor also significantly increased the likelihood of receiving osteoporosis treatment among women with osteopenia. In Chapter 4 of this dissertation we systematically reviewed a growing literature examining whether women receive appropriate treatment for osteoporosis. Studies of osteoporosic fracture patients consistently found a wide gap in treatment, though treatment frequency was higher for spinal fractures than for other fractures, and treatment rates appeared to have increased over time