RESEARCH - Studies examine osteoporosis management in women with fractures

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Studies examine osteoporosis management in women with fractures

12/27/2004

By: Shalmali Pal

Doctors often overlook osteoporosis and its associated risks in women who

present with fractures, according to two recent studies. The first looked at

bone mineral density (BMD) thresholds for pharmacologic intervention to

prevent fractures. The second evaluated the management of osteoporosis in

fracture patients.

Using data from the National Osteoporosis Risk Assessment, a

multi-institutional group examined treatment thresholds one year after a

bone densitometry exam (DEXA). The investigators were led by Dr. Ethel Siris

from the Toni Stabile Osteoporosis Center at Columbia-Presbyterian Medical

Center in New York City. Siris' co-authors are from institutions in

California, Colorado, land, and Pennsylvania.

The study included 149,542 Caucasian, postmenopausal women, ranging in age

from 50-104. Baseline BMD was measured by peripheral bone DEXA at the heel,

finger, or forearm. The patients were followed for the next 12 months.

The results showed that a total of 2,340 new osteoporotic fractures were

reported by 2,259 women during that time period. " Fracture rates were

highest in women with the lowest T scores, " the group stated. " More than 80%

of women who reported having a fracture within 12 months had peripheral T

scores higher than -2.5, and two-thirds had T scores exceeding -2.0 "

(Obstetrical & Gynecological Survey, November 2004, Vol. 59:11, pp.

769-771).

The authors noted that treating only women with a T score of -2.5 or less

would not significantly reduce fractures. Instead, physicians should pay

closer attention to women with moderate loss of bone mass who are still at

an increased fracture risk. In this study, even the women who had a lower T

score still sustained 45% of the osteoporotic fractures and 56% of the hip

fractures.

When these patients do go to the emergency room with fractures, they should

be checked for osteoporosis, according to the second study presented at the

2004 American Osteopathic Association (AOA) meeting in San Francisco.

Stamataros and co-authors from the University of Medicine and

Dentistry of New Jersey in Newark looked at whether postmenopausal women,

who were hospitalized for hip or vertebral fractures, had received pre-event

treatment for osteoporosis. Also, they sought to determine if these women

were discharged with a diagnosis of osteoporosis, as well as treatment

recommendations.

" The significance of treating osteoporosis following a fracture becomes

evident when considering that a previous fracture predicts a second one --

women who have suffered a postmenopausal fracture are more likely to have a

subsequent fracture, " the group wrote in a poster presentation.

For this retrospective review, data was collected from three New Jersey

hospitals, resulting in records for 100 women (ages 55-89) who had been

admitted for hip or vertebral fractures.

Their records were reviewed for the following osteoporosis-related

information:

Admission diagnosis

Risk factors, such as age, weight, tobacco use, and estrogen deficiency

Discharge diagnosis

Treatment recommendations

Of the 100 women, 32 were admitted with an osteoporosis diagnosis and 68

were not. Of the 32 women, 47% were still discharged without a documented

osteoporosis diagnosis, the authors found. Among the 68 women who were not

checked for the disease, 89.7% still did not receive an official diagnosis

at discharge.

The group also found that 77/100 patients had nine or more risk factors for

osteoporosis. Of the 61 women who were not diagnosed either upon admission

or at discharge, 72% had three or more risk factors.

For treatment, 33 women were prescribed some form of osteoporosis treatment,

including calcium and vitamin D supplements and/or medications.

" Overall, these findings suggest there is an insufficient management of

osteoporosis in postmenopausal women who have been hospitalized for a hip or

vertebral fracture, " the group concluded, despite the existence of National

Osteoporosis Foundation guidelines recommending that these women, should

they present with fractures, undergo a DEXA scan. The study results have

inspired the authors to devise an in-house treatment plan at their

institution.

Although experiments have been done with micro-CT and MRI for bone density

testing, DEXA is still the gold standard. For screening purposes, women

under 65 should undergo central DEXA (hip and spine). For women over 65,

heel DEXA is preferred. Baseline screening should be done at the onset of

menopause (AOA's Women and Wellness, September 2004, Vol. 1:2, pp. 10-14).

By Shalmali Pal

AuntMinnie.com staff writer

December 27, 2004

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org