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Osteoporosis Screening Lags Behind Other Diseases

A promising new paper published in the Lancet Diabetes & Endocrinology highlights that screening and treatment for osteoporosis lags behind other diseases, resulting in significant morbidity, mortality and economic costs.

Over the past 30 years, tremendous progress has been made in the diagnosis of osteoporosis, a disease once thought to be an inevitable consequence of aging that weakens bones and can reduce mobility, cause pain, and increase mortality. Unfortunately, despite this progress, the use of dual-energy X-ray absorptiometry (DXA) and fracture risk assessment—tests that can accurately diagnose osteoporosis and determine the likelihood of a hip or other bone fracture—is declining. The use of DXA in women aged 65 and older is projected to decline to 11.3% in 2014 from 13.2% five years earlier. The decline coincided with a 70 percent reduction in Medicare reimbursement for in-office scanning.

The review, titled “Osteoporosis in the US: Prevention and Unmet Needs,” highlights that many at-risk patients are discouraged from taking prophylactic drugs and may be overly afraid of taking them. Failures in primary prevention of osteoporosis are exacerbated by inadequate follow-up after fracture. The review noted that after 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 years and older received standard osteoporosis drugs within 12 months of fracture.

“In addition, studies have shown significantly lower screening rates with bone density scans and treatments in non-Hispanic black women, with discrepancy estimates as high as 20% compared to white non-Hispanic women. This discrepancy is also present in the diagnosis and treatment of fractures,” said co-author Douglas P. Kiehl, MD, MD, Director of the Center for Musculoskeletal Research and Senior Research Fellow at the Hinda and Arthur Marcus Institute for Aging Research, SeniorLife Hebrew and Professor of Medicine , Harvard Medical School. “Our review uncovered some myths about osteoporosis patients. Osteoporosis is believed to affect non-Hispanic white and Asian women, and this may be why screening, prevention, and treatment for fractures in non-Hispanic black women is much lower.”

The cuts in Medicare reimbursement for DXA are also predicted to disenfranchise rural communities. “Understanding the impact of access to screening and treatment for osteoporosis will help the country reduce disparities in care,” added Dr. Kiel. “Major gaps remain in how the US serves patients with this important age-related chronic disease, and it is clear that we need to address disparities and access to standards of care.”

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

The Mayo Clinic and the American Society for Bone and Mineral Research of the University of Alabama collaborated on this promising paper.

Other contributors include: Sandeep Khosla, MD, Head of the Osteoporosis and Bone Biology Laboratory, Mayo Clinic Kogod Aging Center; Ann L. Elderkin, Pennsylvania, former Executive Director of the American Society for Bone and Mineral Research (ASBMR); and Nicole S. Wright, Ph.D., M.P.H., assistant professor of epidemiology at the University of Alabama at Birmingham (UAB).

About Hebrew SeniorLife

/Public version. This material from the original organization/author(s) may be of a point-in-time nature, edited for clarity, style and length. The views and opinions expressed are those of the author(s). View in full here.

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