A study by Stanford Medicine researchers shows that despite recent advances in public awareness and treatment of osteoporosis, millions of American osteoporosis sufferers remain undiagnosed and untreated and may only learn of their condition when they suffer a fracture.
Osteoporosis is a serious health condition that affects over 44 million Americans. The human and economic costs for this condition may account for some $17 billion in direct expenditures in hospitals and nursing homes and that annual expense is expected to triple by 2040.
Writing in the July 26 issue of Archives of Internal Medicine, the research group estimates that fewer than half of the people with osteoporosis have been recognized as such. "If a person's doctor hasn't diagnosed osteoporosis, there's no way they could be on optimal treatment for their bone condition," said Randall Stafford, MD, PhD, assistant professor of medicine in the Stanford Prevention Research Center, who led the study.
Osteoporosis is a condition where the loss of calcium in the bone results in bones becoming weakened and fragile. Older women tend to be at risk to develop this condition. Additional risk occurs with the presence of rheumatoid arthritis and the use of corticosteriods.
About 10 million Americans have osteoporosis and 34 million more are at risk, but the weak bones that characterize the condition often go unnoticed until they fracture, most frequently in the hip, spine or wrist. Among the older people (mainly women) most susceptible to osteoporosis, this can present major problems. "The gravity of fractures is often underappreciated when in fact patients with hip fractures go on to have deterioration in their health linked directly to their fractures, with a high probability of death or nursing home placement," Stafford said.
Both recognition and treatment of osteoporosis have increased noticeably in the past 10 years, the research group found. Stafford attributes this to a constellation of factors, including the emergence of new drugs, more marketing of medications, increased public awareness and better screening technology.
One cause for concern, Stafford said, is that as prescriptions for newer anti-osteoporosis drugs have increased, the use of calcium supplements has decreased. Doctors reported treating 43 percent of osteoporosis patients with calcium supplements in 1994, but only 24 percent last year. "Physicians and patients may be so enamored of the new drugs that they are neglecting this important component of osteoporosis treatment," Stafford said. This would be a mistake, he noted, because newer osteoporosis medications were tested on people taking extra calcium and may not work as well without it.
The results of the study, which used data from an ongoing national physician survey, also point to a path to increase the diagnosis and treatment of osteoporosis. Since most osteoporosis is recognized and treated by primary care physicians, these physicians are the best targets for improvement efforts, Stafford said. "It's not a matter of the knowledge being out there, but it's a matter of the knowledge being implemented by the physicians who are providing most of the care," he explained.