Clinicians Don’t Always Follow Guidelines for Osteoporosis
Many women receive inappropriate screening and treatment.
As the number of menopausal women continues to rise, osteoporosis screening and treatment assume greater importance. U.S. investigators conducted a study in women who had undergone dual x-ray absorptiometry from 2007 to 2009 to determine whether they met criteria for bone-mineral density (BMD) testing and subsequent treatment in accord with the 2006 North American Menopause Society (NAMS) guidelines. These guidelines specify that screening should not be initiated until age 65 (unless certain risk factors are present) and that treatment should be initiated only in osteoporotic women (or selected high-risk women with T scores between 2.5 and 2.0).
Among 615 evaluable women (mean age, 62; 95% non-Latina white), 41% did not meet criteria for BMD assessment. In all, 22% of participants were using bisphosphonates, 11% were using hormone therapy, 3% were using raloxifene, and 1% were using calcitonin. Among 102 women with any indication for treatment, 35% were not using any of these pharmacologic therapies. Among 467 women who had no indications for treatment, 18% were receiving therapy with bisphosphonates, raloxifene, or calcitonin.
Comment: These findings suggest that U.S. clinicians are inappropriately screening many women and are often failing to intervene appropriately when indications for treatment are present. The NAMS guidelines were updated in 2010 (JW Womens Health Feb 18 2010), and some clinicians might follow other guidelines; however, all current recommendations are similar. Educating patients about reasons that screening tests are not indicated can be challenging and time-consuming. Nonetheless, the heightened awareness of risks associated with long-term bisphosphonate use (JW Gen Med Dec 15 2009 and JW Gen Med Mar 3 2011) can facilitate conversations about why women at low risk generally do not need treatment.
Andrew M. Kaunitz, MD
Published in Journal Watch Women’s Health November 10, 2011
Schnatz PF et al. Osteoporosis screening and treatment guidelines: Are they being followed? Menopause 2011 Oct; 18:1072.