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Treatment of Osteoporosis: Are Physicians Missing an Opportunity?*†

Freedman, Kevin B. M.D., M.S.C.E.‡; Kaplan, Frederick S. M.D.‡; Bilker, Warren B. Ph.D.‡; Strom, Brian L. M.D., M.P.H.‡; Lowe, Robert A. M.D.‡, M.P.H.

Journal of Bone & Joint Surgery - American Volume: August 2000 - Volume 82 - Issue 8 - p 1063
Article

Background: Medical treatment of women with established osteoporosis may decrease the incidence of future fractures. Postmenopausal women who have sustained a distal radial fracture have decreased bone-mineral density and nearly twice the risk of a future hip fracture. The purpose of this study was to evaluate the adequacy of diagnosis and treatment of osteoporosis in postmenopausal women following an acute fracture of the distal part of the radius.

Methods: A retrospective cohort study was performed with use of a claims database that includes more than three million patients, from thirty states, enrolled in multiple health plans. All women, fifty-five years of age or older, who sustained a distal radial fracture between July 1, 1994, and June 30, 1997, were identified in the database. Only patients with at least six months of continuous and complete medical and pharmaceutical health-care coverage from the date of the fracture were enrolled, to ensure that all health-care claims would be captured in the database. This cohort of patients was then evaluated to determine the proportion who had undergone either a diagnostic bone-density scan or treatment with any recommended medication for established osteoporosis (estrogen, a bisphosphonate, or calcitonin) within six months following the fracture.

Results: A search of the database identified 1162 women, fifty-five years of age or older, who had a distal radial fracture. Of these 1162 patients, thirty-three (2.8 percent) underwent a bone-density scan and 266 (22.9 percent) were treated with at least one of the medications approved for treatment of established osteoporosis. Twenty women had both a bone-density scan and drug treatment. Therefore, only 279 (24.0 percent) of the 1162 women who sustained a distal radial fracture underwent either diagnostic evaluation or treatment of osteoporosis. There was a significant decrease in the rate of treatment of osteoporosis with increasing patient age at the time of the fracture (p < 0.0001).

Conclusions: Current physician practice may be inadequate for the diagnosis and treatment of osteoporosis in postmenopausal women who have sustained a distal radial fracture.

†Winner of the American Orthopaedic Association/Zimmer Annual Travel Awards Competition for United States Orthopaedic Residents.

‡Department of Orthopaedic Surgery (K. B. F. and F. S. K.), Center for Clinical Epidemiology and Biostatistics (K. B. F., W. B. B., B. L. S., and R. A. L.), Department of Biostatistics and Epidemiology (K. B. F., W. B. B., B. L. S., and R. A. L.), Department of Emergency Medicine (R. A. L.), Leonard Davis Institute for Health Economics (R. A. L.), and Division of General Internal Medicine (F. S. K. and B. L. S.), University of Pennsylvania School of Medicine, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. E-mail address for K. B. Freedman: kfreedma@mail.med.upenn.edu.

Copyright 2000 by The Journal of Bone and Joint Surgery, Incorporated
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