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Bone Mineral Density Measurement and Treatment for Osteoporosis in Older Individuals With Fractures
A Gap in Evidence-Based Practice Guideline Implementation
Adrianne Feldstein, MD, MS;
Patricia J. Elmer, PhD, MS;
Eric Orwoll, MD;
Michael Herson, MD;
Teresa Hillier, MD, MS
Arch Intern Med. 2003;163:2165-2172.
Background Osteoporosis evaluation and treatment guidelines state that, because of the high risk for future fractures, a fracture in an older individual warrants initiation of pharmacological treatment or bone mineral density (BMD) measurement followed by treatment according to BMD. We compared current practice with these guidelines.
Methods We used the electronic data systems of a health maintenance organization to collect fracture, BMD measurement, and pharmacy data for women aged 50 to 89 years and men aged 65 to 89 years who sustained a study-defined fracture during 1998 or 1999. We determined those who had BMD measurement or pharmacological treatment for osteoporosis (bisphosphonate or estrogen) during the 2 years. We compared the evaluation and treatment data with evidence-based clinical guidelines (for women) or expert consensus (for men).
Results Of 70 513 members in the eligible age groups, 2804 persons sustained study-defined fractures. Overall, only 4.6% of those with fractures had treatment initiated after the fracture. Women sustained 80.7% of the study-defined fractures; 8.4% had BMD measurement and 42.4% received any treatment during the 2 years. Bone mineral density measurement and treatment frequency decrease significantly with age in women. In men, 1.5% had BMD measurement and 2.8% received any treatment. Approximately 51% (51.2%) of women and 95.5% of men in our study population were not evaluated or treated in accord with guideline or expert recommendations.
Conclusions Evaluation and treatment rates for osteoporosis in older individuals with fractures fall far below national recommendations, especially for men. Intervention strategies should be developed and evaluated to prevent refracture in older individuals with fractures.
From the Center for Health Research, Kaiser Permanente (Drs Feldstein, Elmer, and Hillier), Department of Endocrinology and Bone and Mineral/Osteoporosis, Oregon Health & Science University (Dr Orwoll), and Northwest Permanente (Drs Feldstein and Herson), Portland, Ore. Drs Feldstein and Elmer have received research grants from Merck & Co, Inc, Westpoint, Penn. Dr Orwoll has received research grants from Eli Lilly, Indianapolis, Ind; Merck & Co, Inc; and Pfizer, New York, NY. He has consulted with Eli Lilly; Merck & Co, Inc; Procter & Gamble, Cincinnati, Ohio; Roche Laboratories, Nutley, NJ; NPS, Salt Lake City, Utah; and Novartis, East Hanover, NJ.
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