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The potential impact of the National Osteoporosis Foundation guidance on treatment eligibility in the USA: an update in NHANES 2005–2008

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Abstract

Summary

This analysis of National Health and Nutrition Examination Survey (NHANES) 2005–2008 data describes the prevalence of risk factors for osteoporosis and the proportions of men and postmenopausal women age 50 years and older who are candidates for treatment to lower fracture risk, according to the new Fracture Risk Assessment Tool (FRAX)-based National Osteoporosis Foundation Clinician’s Guide.

Introduction

It is important to update estimates of the proportions of the older US population considered eligible for pharmacologic treatment for osteoporosis for purposes of understanding the health care burden of this disease.

Methods

This is a cross-sectional study of the NHANES 2005–2008 data in 3,608 men and women aged 50 years and older. Variables in the analysis included race/ethnicity, age, lumbar spine and femoral neck bone mineral density, risk factor profiles, and FRAX 10-year fracture probabilities.

Results

The prevalence of osteoporosis of the femoral neck ranged from 6.0% in non-Hispanic black to 12.6% in Mexican American women. Spinal osteoporosis was more prevalent among Mexican American women (24.4%) than among either non-Hispanic blacks (5.3%) or non-Hispanic whites (10.9%). Treatment eligibility was similar in Mexican American and non-Hispanic white women (32.0% and 32.8%) and higher than it was in non-Hispanic black women (11.0%). Treatment eligibility among men was 21.1% in non-Hispanic whites, 12.6% in Mexican Americans, and 3.0% in non-Hispanic blacks.

Conclusions

Nineteen percent of older men and 30% of older women in the USA are at sufficient risk for fracture to warrant consideration for pharmacotherapy.

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References

  1. National Osteoporosis Foundation (2008) Clinician's guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, D.C., pp 1–36

    Google Scholar 

  2. Kanis J (2008) Assessment of osteoporosis at the primary health-care level. WHO Collaborating Centre, University of Sheffield, Sheffield

    Google Scholar 

  3. Dawson-Hughes B, Looker AC, Tosteson AN, Johansson H, Kanis JA, Melton LJ 3rd (2010) The potential impact of new National Osteoporosis Foundation guidance on treatment patterns. Osteoporos Int 21:41–52

    Article  PubMed  CAS  Google Scholar 

  4. AC Looker AC LMI, LG Borrud, JA Shepherd (2011) Changes in femur neck bone density in US adults between 1988–1994 and 2005–2008: demographic patterns and possible determinants. Osteoporosis International 22: doi:10.1007/s00198-011-1623-0

  5. Centers for Disease Control and Prevention NCHS (1999–2011) National Health and Nutrition Examination Survey (NHANES). US Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville

    Google Scholar 

  6. Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S (2008) Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 11:75–91

    Article  PubMed  Google Scholar 

  7. Centers of Disease Control and Prevention NCHS (2006) National Health and Nutrition Survey: body composition procedure manual. US Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville

    Google Scholar 

  8. Centers for Disease Control and Prevention NCHS (2007) National Health and Nutrition Examination Survey: dual-energy x-ray absorptiometry (DXA) procedure manual. U.S Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville

    Google Scholar 

  9. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  PubMed  CAS  Google Scholar 

  10. Kelly TJ (1990) Bone mineral density reference databases for American men and women. J Bone Miner Res 5(Suppl 1):S249

    Google Scholar 

  11. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141

    Article  PubMed  CAS  Google Scholar 

  12. McKinlay SM (1994) Issues in design, measurement, and analysis for menopause research. Exp Gerontol 29:479–493

    Article  PubMed  CAS  Google Scholar 

  13. Kanis JA, Johansson H, Oden A, Dawson-Hughes B, Melton LJ 3rd, McCloskey EV (2010) The effects of a FRAX revision for the USA. Osteoporos Int 21:35–40

    Article  PubMed  CAS  Google Scholar 

  14. Dawson-Hughes B, Tosteson AN, Melton LJ 3rd, Baim S, Favus MJ, Khosla S, Lindsay RL (2008) Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int 19:449–458

    Article  PubMed  CAS  Google Scholar 

  15. Centers for Disease Control and Prevention NCHS (2010) National Health and Nutrition Examination Survey NHANES response rates and CPS totals. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville, MD. Available at http://www.cdc.gov/nchs/nhanes/response_rates_CPS.htm

  16. Donaldson MG, Cawthon PM, Lui LY, Schousboe JT, Ensrud KE, Taylor BC, Cauley JA, Hillier TA, Black DM, Bauer DC, Cummings SR (2009) Estimates of the proportion of older white women who would be recommended for pharmacologic treatment by the new U.S. National Osteoporosis Foundation Guidelines. J Bone Miner Res 24:675–680

    Article  PubMed  Google Scholar 

  17. Donaldson MG, Cawthon PM, Lui LY, Schousboe JT, Ensrud KE, Taylor BC, Cauley JA, Hillier TA, Dam TT, Curtis JR, Black DM, Bauer DC, Orwoll ES, Cummings SR (2010) Estimates of the proportion of older white men who would be recommended for pharmacologic treatment by the new US National Osteoporosis Foundation guidelines. J Bone Miner Res 25:1506–1511

    Article  PubMed  Google Scholar 

  18. Berry SD, Kiel DP, Donaldson MG, Cummings SR, Kanis JA, Johansson H, Samelson EJ (2010) Application of the National Osteoporosis Foundation Guidelines to postmenopausal women and men: the Framingham Osteoporosis Study. Osteoporos Int 21:53–60

    Article  PubMed  CAS  Google Scholar 

  19. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 286:2815–2822

    Article  PubMed  CAS  Google Scholar 

  20. Araujo AB, Travison TG, Harris SS, Holick MF, Turner AK, McKinlay JB (2007) Race/ethnic differences in bone mineral density in men. Osteoporos Int 18:943–953

    Article  PubMed  CAS  Google Scholar 

  21. Zingmond D (2004) Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 15:603–610

    Article  PubMed  Google Scholar 

  22. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475

    Article  PubMed  Google Scholar 

  23. Siris ES, Pasquale MK, Wang Y, Watts NB (2011) Estimating bisphosphonate use and fracture reduction among US women aged 45 years and older, 2001–2008. J Bone Miner Res 26:3–11

    Article  PubMed  Google Scholar 

  24. Jaglal SB, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L, Adachi JD (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905

    Article  PubMed  Google Scholar 

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Correspondence to B. Dawson-Hughes.

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This material is based on work supported by the U.S. Department of Agriculture, Agricultural Research Service, under agreement No. 58-1950-7-707. Any opinions, findings, conclusion, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Agriculture, the Centers for Disease Control and Prevention, or the U.S. Department of Health and Human Services.

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Dawson-Hughes, B., Looker, A.C., Tosteson, A.N.A. et al. The potential impact of the National Osteoporosis Foundation guidance on treatment eligibility in the USA: an update in NHANES 2005–2008. Osteoporos Int 23, 811–820 (2012). https://doi.org/10.1007/s00198-011-1694-y

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