Insights From Clinical Osteoporosis 2010
Premeeting Overview
CME Information
Missed Opportunities in Osteoporosis Diagnosis and Treatment
Although effective clinical tools are available to screen, diagnose, and treat osteoporosis, the disease remains underdiagnosed and undertreated.1-3 Even among patients who suffer a fragility fracture, adequate osteoporosis management is the exception rather than the rule.4 Screening and treatment rates, although low for all populations, are particularly reduced for men.5 Several chemotherapy regimens (in addition to the malignancies themselves) can contribute to decreased bone density and an increased incidence of fractures. Treatment with aromatase inhibitors (as in breast cancer) and androgen deprivation therapy (as in prostate cancer) has been associated with increased fracture risk.6,7 The increased fracture risk conferred by these diseases is not accounted for in commonly used clinical tools such as the World Health Organization's Fracture Risk Assessment Tool (FRAX®), thus use of these tools may result in an underestimation of the risk associated with these therapies.6 In light of this, evidence-based recommendations for the management of patients with osteoporosis of varying etiologies—such as the National Osteoporosis Foundation's Clinicians Guide to Prevention and Treatment of Osteoporosis and those published by Hadji et al—have been developed.7-9
Many barriers to optimal management of osteoporosis have been described. Frequently, patients presenting with fractures consistent with osteoporosis (eg, hip fractures) do not receive bone mineral testing or appropriate therapy.10 Undertreatment may be a consequence of poor communication between physicians who provide immediate postfracture care and primary care physicians who might evaluate for and treat osteoporosis.11 Rates of screening can be increased by the use of chart reminders and mailed patient education materials.12
Many patients who are diagnosed with osteoporosis and started on pharmacotherapy do not adhere to the prescribed medication regimen.13 Reasons for poor adherence are varied and can include complicated dosing schemes, concerns regarding side effects, and the cost of medication.14-16 A perceived lack of treatment efficacy combined with a perception that osteoporosis is not "serious" may also hinder treatment.14,17 Studies are under way to evaluate potential mechanisms for improving patient adherence with osteoporosis therapy.18
