A new perspective article published in The Lancet Diabetes and Endocrinology emphasizes that osteoporosis screening and treatment lags behind other diseases, resulting in significant morbidity, mortality, and economic costs.
Over the last 30 years, there has been a significant improvement in the ability to diagnose osteoporosis. Osteoporosis was thought to be an inevitable consequence of aging that weakens bones, reduces mobility, causes pain, and increases mortality.
Unfortunately, despite these advances, the use of dual-energy X-ray absorptiometry (DXA) and fracture risk assessment (a test that can accurately diagnose osteoporosis and determine the likelihood of hip and other fractures) remains elusive. is declining. According to the outlook, her DXA use among women 65 years and older has decreased from 13.2% of her five years ago to 11.3% of her in 2014. This decline coincides with her 70% decrease in Medicare reimbursement for office-based scans.
A review entitled “Osteoporosis in the United States: Prevention and Unmet Needs” found that many at-risk patients were not advised to take preventive medications and may be overly afraid to take them. Failure of primary prevention of osteoporosis is exacerbated by inadequate follow-up care after fracture.
The review noted that post-fracture patients did not receive effective medication, which contrasts with treatment of post-heart attack patients. Ninety-six percent of patients with acute myocardial infarction (AMI) received standard-of-care medications, whereas only 30% of women aged 66 and older received standard-of-care medications to treat osteoporosis 12 months after fracture. I received treatment medication.
“Furthermore, studies show that a significantly lower sieving It has been estimated that there is an estimated 20% difference in bone density scans and treatments for non-Hispanic black women compared to non-Hispanic white women. This disparity is also seen in post-fracture diagnosis and treatment,” said co-author Douglas P. Kiel, MD, MPH, Director, Musculoskeletal Research Center and Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life. and Professor said. Medicine, Harvard Medical School.
“Our review highlighted several myths about patients with osteoporosis. Osteoporosis is thought to affect non-Hispanic white and Asian women, which is why screening of non-Hispanic black women , prophylaxis, and post-fracture treatment are so low.”
The cut in DXA’s Medicare reimbursement has also disenfranchised rural communities, according to the outlook. “Understanding the implications of osteoporosis screening and access to treatment will help countries reduce disparities in care,” added Dr. Kiel. It is clear that gaps in and access to standard care need to be addressed.”
Another complicating factor is that there are currently no clear options for primary prevention of osteoporosis. Estrogen was widely used in postmenopausal young women. osteoporosisHowever, studies by the Women’s Health Initiative have raised concerns about its long-term safety and left gaps in treatment options.
Sundeep Khosla et al., Osteoporosis in the United States: Prevention and Unmet Needs, The Lancet Diabetes and Endocrinology (2022). DOI: 10.1016/S2213-8587(22)00322-9
Courtesy of Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research
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