nach oben

Erschienen in:

01.08.2009 | Original Article

Population-Based Fracture Risk Assessment and Osteoporosis Treatment Disparities by Race and Gender

verfasst von: Jeffrey R. Curtis, MD MPH, Leslie A. McClure, PhD, Elizabeth Delzell, ScD, Virginia J. Howard, PhD, Eric Orwoll, MD, Kenneth G. Saag, MD MSc, Monika Safford, MD, George Howard, DrPh

Erschienen in: Journal of General Internal Medicine | Ausgabe 8/2009

Einloggen, um Zugang zu erhalten

ABSTRACT

BACKGROUND

Undertreatment of osteoporosis has been recognized as a common problem in selected patient subgroups. However, primary prevention has been hampered by limited risk assessment tools that can be applied to large populations.

OBJECTIVES

Using clinical risk factors with a new tool from the World Health Organization (FRAX) and recommendations from the National Osteoporosis Foundation (NOF), we evaluated fracture risk and osteoporosis treatment in a US cohort.

PARTICIPANTS

African Americans and Caucasians recruited from 2003–7 across the US as part of a longitudinal study.

DESIGN

Cross-sectional.

MEASURES

The number of persons receiving prescription osteoporosis medications was assessed by race, sex, and fracture risk. Multivariable logistic regression evaluated the association between receipt of osteoporosis medications and fracture risk after controlling for potential confounders.

RESULTS

Among 24,783 participants, estimated fracture risk was highest for Caucasian women. After multivariable adjustment for fracture-related risk factors, the likelihood of receipt of osteoporosis medications among African Americans was lower than among Caucasians [odds ratio (OR) = 0.44, 95% confidence interval (CI) 0.37, 0.53] and for men compared to women (OR = 0.08, 95% CI 0.06–0.10). Even for the highest risk group, Caucasian women with 10-year hip fracture risk ≥3% (n = 3,025, 39.7%), only 26% were receiving treatment.

CONCLUSIONS

A substantial gap exists between 2008 NOF treatment guidelines based on fracture risk and the receipt of prescription osteoporosis medications. This gap was particularly notable for African Americans and men. FRAX is likely to be useful to assess risk at a population level and identify high-risk persons in need of additional evaluation.

Nur mit Berechtigung zugänglich

National Osteoporosis Foundation: Clinician’s Guide to Prevention and Treatment of Osteoporosis. 2008 [updated 2008; cited accessed April 10, 2008].

Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22(3):465–75.PubMedCrossRef

Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health. 1990;80:871–3.PubMedCrossRef

Kellie S, Brody J. Sex specific and Race specific Hip Fracture Rates. Am J Public Health. 1990;80(3):326–8.PubMedCrossRef

Jacobsen S, Goldberg J, Miles T, Brody J, Stiers W, Rimm A. Race and sex differences in mortality following fracture of the hip. Am J Public Health. 1992;82(8):1147–50.PubMedCrossRef

Mikuls TR, Saag KG, George V, Mudano AS, Banerjee S. Racial disparities in the receipt of osteoporosis related healthcare among community-dwelling older women with arthritis and previous fracture. J Rheumatol. 2005;32(5):870–5.PubMed

Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468–89.PubMedCrossRef

Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, et al. Proximal femur bone mineral levels of US adults. Osteoporos Int. 1995;5(5):389–409.PubMedCrossRef

Lewiecki EM, Watts NB, McClung MR, Petak SM, Bachrach LK, Shepherd JA, et al. Official positions of the international society for clinical densitometry. J Clin Endocrinol Metab. 2004;89(8):3651–5.PubMedCrossRef

10.

Curtis JR, Carbone L, Cheng H, Hayes B, Laster A, Matthews R, et al. Longitudinal trends in use of bone mass measurement among older americans, 1999–2005. J Bone Miner Res. 2008;23(7):1061–7.PubMedCrossRef

11.

Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA. 2002;288(15):1889–97.PubMedCrossRef

12.

Melton LJ 3rd, Johnell O, Lau E, Mautalen CA, Seeman E. Osteoporosis and the global competition for health care resources. J Bone Miner Res. 2004;19(7):1055–8.PubMedCrossRef

13.

Black DM, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni MS, et al. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int. 2001;12(7):519–28.PubMedCrossRef

14.

Schneyer CR, Lopez H, Concannon M, Hochberg MC. Assessing population risk for postmenopausal osteoporosis: a new strategy using data from the Behavioral Risk Factor Surveillance System (BRFSS). J Bone Miner Res. 2008;23(1):151–8.PubMedCrossRef

15.

Kanis JA, for WHO Scientific Group. Assessment of Osteoporosis at the Primary Care Level. Technical Report.: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK; 2007.

16.

Dawson-Hughes B, Tosteson AN, Melton LJ 3rd, Baim S, Favus MJ, Khosla S, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19(4):449–58.PubMedCrossRef

17.

Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, et al. The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiology. 2005;25(3):135–43.PubMedCrossRef

18.

Chen Z, Kooperberg C, Pettinger M, Bassford T, Cauley J, LaCroix AZ, et al. Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women’s Health Initiative observational study and clinical trials. Menopause. 2004;11(3):264–74.PubMedCrossRef

19.

Melchior L, Huba G, Brown V, Reback C. A short depression index for women. Educ Psychol Meas. 1993;53:1117–25.CrossRef

20.

World Health Organization Fracture Risk Assessment Tool. Available from: http://shef.ac.uk/FRAX. Accessed May 31st, 2008.

21.

Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19(4):437–47.PubMedCrossRef

22.

Hosmer JDW, Lemeshow S. Applied Logistic Regression: 2nd Edition. John Wiley and Sons; 2000.

23.

Lemeshow S, Hosmer JDW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115:92–106.PubMed

24.

Curtis JR, Arora T, Donaldson M, Alarcon G, Callahan L, Moreland L, Bridges L, Mikuls TR. Skeletal health among African Americans with recent onset rheumatoid arthritis. Arthritis Care and Research. In press.

25.

Gourlay ML, Callahan LF, Preisser JS, Sloane PD. Osteoporosis preventive care in white and black women in community family medicine settings. South Med J. 2007;100(7):677–82.PubMed

26.

Mudano A, Casebeer L, Patino F, Allison J, Weissman N, Kiefe C, et al. Racial disparities in osteoporosis prevention in a managed care population. South Med J. 2003;96(5):445–51.PubMedCrossRef

27.

Block AE, Solomon DH, Cadarette SM, Mogun H, Choudhry NK. Patient and physician predictors of post-fracture osteoporosis management. J Gen Intern Med. 2008;23(9):1447–51.PubMedCrossRef

28.

Solomon DH, Morris C, Cheng H, Cabral D, Katz JN, Finkelstein JS, et al. Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc. 2005;80(2):194–202.PubMedCrossRef

29.

Curtis JR, Westfall AO, Allison JJ, Becker A, Casebeer L, Freeman A, et al. Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patients. Arthritis Rheum. 2005;52(8):2485–94.PubMedCrossRef

30.

Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int. 2004;15(10):767–78.PubMedCrossRef

31.

Hamrick I, Whetstone LM, Cummings DM. Racial disparity in treatment of osteoporosis after diagnosis. Osteoporos Int. 2006;17(11):1653–8.PubMedCrossRef

32.

Morris CA, Cabral D, Cheng H, Katz JN, Finkelstein JS, Avorn J, et al. Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med. 2004;19(7):783–90.PubMedCrossRef

33.

Binkley N, Kiebzak GM, Lewiecki EM, Krueger D, Gangnon RE, Miller PD, et al. Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res. 2005;20(2):195–201.PubMedCrossRef

34.

Mikuls TR, Saag KG, Curtis J, Bridges SL Jr., Alarcon GS, Westfall AO, et al. Prevalence of osteoporosis and osteopenia among African Americans with early rheumatoid arthritis: the impact of ethnic-specific normative data. J Natl Med Assoc. 2005;97(8):1155–60.PubMed

35.

Broussard DL, Magnus JH. Risk assessment and screening for low bone mineral density in a multi-ethnic population of women and men: does one approach fit all? Osteoporos Int. 2004;15(5):349–60.PubMedCrossRef

36.

Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, et al. A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int. 2001;12(8):699–705.PubMedCrossRef

37.

Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293(17):2102–8.PubMedCrossRef

38.

Looker AC, Flegal KM, Melton LJ 3rd. Impact of increased overweight on the projected prevalence of osteoporosis in older women. Osteoporos Int. 2007;18(3):307–13.PubMedCrossRef

39.

Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum. 2006;36(3):182–8.PubMedCrossRef

Titel: Population-Based Fracture Risk Assessment and Osteoporosis Treatment Disparities by Race and Gender
verfasst von: Jeffrey R. Curtis, MD MPH
Leslie A. McClure, PhD
Elizabeth Delzell, ScD
Virginia J. Howard, PhD
Eric Orwoll, MD
Kenneth G. Saag, MD MSc
Monika Safford, MD
George Howard, DrPh
Publikationsdatum: 01.08.2009
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 8/2009
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-009-1031-8

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

ABSTRACT

BACKGROUND

OBJECTIVES

PARTICIPANTS

DESIGN

MEASURES

RESULTS

CONCLUSIONS

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2009

More Than a Pain in the Neck: How Discussing Chronic Pain Affects Hypertension Medication Intensification

Statewide Evaluation of Measuring Physician Delivery of Self-Management Support in Chronic Disease Care

How Well Do Guidelines Incorporate Evidence on Patient Preferences?

REFLECTION

Internal Medicine Resident Self-report of Factors Associated with Career Decisions