Identification of osteoporosis treatment gaps

Abstract

Background/aims Osteoporosis is implicated in over 8.9 million fragility fractures worldwide with a cost in the United States of America of 19 billion dollars. The number of osteoporosis-related fractures and the associated human and financial costs are projected to continue to rise as the American population ages (Zeldow, 2018). Screening and identification of patients with decreased bone density can prevent or delay the onset of this insidious condition. This study was developed to evaluate the following research questions: 1. Which risk factors are most strongly associated with the completion of Dual x-ray absorptiometry (DXA) screening? 2. When patients are provided instruction on osteoporosis screening guidelines from a health care provider, how likely are they to comply with DXA screening? 3. Which healthcare providers are providing instruction on osteoporosis guidelines to patients? Methods A 22-question osteoporosis survey addressing history of fracture, modifiable and non-modifiable risk factors, and compliance with recommendations was developed by the authors and distributed to a sample of 270 patients presenting to medical offices during a 1-month period in 2018. Results It was found that 49.26% (n=133) of patients reported they received counseling regarding osteoporosis prevention while 50.74% (n=137) of patients reported that bone health was never addressed by any healthcare provider. Those healthcare providers that did discuss bone health with their patients were noted to most frequently practice in the primary care setting 30.7% (n=83). Other healthcare providers patients identified in the survey as discussing bone health were specialists in orthopaedics at 8.5% (n=23), obstetrics/gynecology 7% (n=19), rheumatology 2.6% (n=7), oncology 2.9% (n=8), and endocrinology 1% (n=3). The risk factors most strongly associated with the completion of DXA screening in this survey were loss of height, fracture after 50 years of age, and oral corticosteroid use. Conclusions Osteoporosis is considered a ‘silent disease’ that often goes unrecognised by providers and patients until after fracture occurs. This study highlights the need for providers to educate on bone health and to find better ways to ensure patient compliance.