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What's New - Osteoporosis Testing

Majority of Older Women with Fractures Don't Receive Recommended Testing and Treatment for Osteoporosis

(PORTLAND, Ore.) - A new study, conducted by researchers at Kaiser Permanente's Center for Health Research (CHR) in Portland, shows that nearly 54 percent of older women who suffered a fracture - a strong indicator of osteoporosis - were not evaluated or treated for that bone-thinning condition.  The study also found important differences between women who did and did not receive treatment that may help researchers and clinicians design more effective ways to prevent future fractures.  Results of the study, funded by the federal Agency for Healthcare Research and Quality, appear in the December 2003 issue of The Journal of Bone and Joint Surgery.

"We conducted this study to identify the gaps between osteoporosis guidelines and actual clinical practice," says Adrianne Feldstein, MD, lead author and assistant medical liaison for research and adjunct investigator at CHR. "This kind of information is needed so researchers, clinicians, and health systems can design improved systems of care.  Based on this information, we have designed and conducted a clinical intervention study to prevent re-fractures in older women.  Results of that study will be available in mid-2004."

National guidelines for evaluating and treating osteoporosis were first published in 1996.  They recommend that older women with fractures should either receive medications for osteoporosis if the condition is apparent, or they should have a bone mineral density (BMD) measurement, followed by medication treatment if indicated.  However, several studies across the country have found a substantial gap between guideline recommendations and actual clinical practice.  In the CHR study, of 3,812 women age 50 and over who had a new fracture diagnosed between January 1998 and July 2001, more than 95 percent did not receive a bone mineral density measurement and nearly 55 percent did not receive a medication for osteoporosis.  During the study period, clinicians who treated these patients had access both to external and internal Web-based clinical guidelines for evaluating and treating osteoporosis.

"Simply providing physicians with clinical guidelines is not enough to change clinical practice," says Dr. Feldstein.  "The gap between guidelines and actual clinical practice means we need to find other ways to improve clinician and patient education and to facilitate action.   Successful strategies in other clinical areas have included academic detailing, computer alerts and reminders, and improved systems of care.  For example, orthopedists who treat older women for fractures could help reduce the gap either by referring patients to their primary care physicians for evaluation or by initiating bone mineral density measurements and then referring patients for treatment."

The study found a number of important differences between women who did and did not receive evaluation and treatment.  Compared to women who received recommended care, women who didn't receive evaluation or treatment were older; weighed less, and had more fractures of the hip, wrist, and humerus (an upper arm bone).  Women who received recommended care were more likely to have had fractures of the spine and to take steroid medication chronically.

"The bottom line for both clinicians and older women patients," Dr. Feldstein says, "is that they should view a fracture as possibly indicating osteoporosis until proven otherwise.  Having a low-impact fracture should trigger evaluation and treatment." Kaiser Permanente's Center for Health Research, founded in 1964, is a non-profit research institution who mission is to advance knowledge to improve health.

Kaiser Permanente Northwest is a group practice health care organization serving about 435,000 people in Oregon and Southwest Washington.

Released: December 8, 2003