Advertisement

Osteoporosis International

, Volume 25, Issue 1, pp 317–324 | Cite as

Use of pharmacologic agents for the primary prevention of osteoporosis among older women with low bone mass

  • J. Zhang
  • E. Delzell
  • J. R. Curtis
  • F. Hooven
  • S. H. Gehlbach
  • F. A. AndersonJr.
  • K. G. SaagEmail author
Original Article

Abstract

Summary

We examined the use of pharmacologic agents for the primary prevention of osteoporosis among older women with osteopenia. We found that these individuals were not managed in concordance with the National Osteoporosis Foundation (NOF) guidelines and that self-perceived osteoporosis risk and lower bone density were strongly associated with receipt of treatment.

Introduction

Although osteoporosis medications are used for the primary prevention of osteoporosis among persons with low bone mass (osteopenia), their use may be discordant with clinical practice guidelines.

Methods

We studied women 55 years and older participating in the Global Longitudinal Study of Osteoporosis in Women (GLOW). Eligible participants had a dual energy x-ray absorptiometry (DXA) test performed at the University of Alabama at Birmingham hospital and had an osteopenia diagnosis based on their DXA test results.

Participants' demographics, fracture risk factors, and exposure to osteoporosis medications were determined from the GLOW survey. We examined the proportions of women managed in concordance with the National Osteoporosis Foundation 2008 guidelines, and we assessed factors independently associated with osteoporosis treatment decisions. Women with a prior spine or hip fracture were excluded.

Results

Among 597 eligible women from GLOW, the mean age ± standard deviation (SD) was 70 ± 7 years. Among all subjects, 309 (52 %) were treated in concordance with the NOF 2008 guidelines. Greater self-perceived osteoporosis risk and lower bone mineral density were significantly and consistently associated with receipt of osteoporosis treatment, both for those considered appropriate and for those considered inappropriate for treatment based on the NOF guidelines.

Conclusions

We found significant discordance between NOF 2008 guidelines and pharmacologic management of women with osteopenia. A person's self-perceived osteoporosis risk and bone mineral density were most strongly associated with receipt of osteoporosis medication use among women with low bone mass.

Keywords

Clinical guidelines Low bone mass Osteoporosis medication Self-perceived osteoporosis risk 

Notes

Conflicts of interest

JZ has received research support from Amgen and Genentech; ED has received research support from Amgen; JRC has received research grants and honoraria, and consulted for Merck, Eli Lilly, Amgen; KGS has received research grants from Amgen and Merck and consulted for Merck and Lily.

References

  1. 1.
    National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis (2010)Google Scholar
  2. 2.
    Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12(11):1761–1768. doi: 10.1359/jbmr.1997.12.11.1761 PubMedCrossRefGoogle Scholar
  3. 3.
    Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, Berger ML (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164(10):1108–1112. doi: 10.1001/archinte.164.10.1108 PubMedCrossRefGoogle Scholar
  4. 4.
    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(4):675–680. doi: 10.1359/jbmr.081203 PubMedCrossRefGoogle Scholar
  5. 5.
    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(1):53–60. doi: 10.1007/s00198-009-1127-3 PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Hooven FH, Adachi JD, Adami S, Boonen S, Compston J, Cooper C, Delmas P, Diez-Perez A, Gehlbach S, Greenspan SL, LaCroix A, Lindsay R, Netelenbos JC, Pfeilschifter J, Roux C, Saag KG, Sambrook P, Silverman S, Siris E, Watts NB, Anderson FA Jr (2009) The Global Longitudinal Study of Osteoporosis in Women (GLOW): rationale and study design. Osteoporos Int 20(7):1107–1116. doi: 10.1007/s00198-009-0958-2 PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37(5):360–363PubMedGoogle Scholar
  8. 8.
    Siris ES, Simon JA, Barton IP, McClung MR, Grauer A (2008) Effects of risedronate on fracture risk in postmenopausal women with osteopenia. Osteoporos Int 19(5):681–686. doi: 10.1007/s00198-007-0493-y PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix AZ (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280(24):2077–2082PubMedCrossRefGoogle Scholar
  10. 10.
    James PA, Cowan TM, Graham RP, Majeroni BA (1997) Family physicians' attitudes about and use of clinical practice guidelines. J Fam Pract 45(4):341–347PubMedGoogle Scholar
  11. 11.
    Vashitz G, Meyer J, Parmet Y, Henkin Y, Peleg R, Gilutz H (2011) Physician adherence to the dyslipidemia guidelines is as challenging an issue as patient adherence. Fam Pract 28(5):524–531. doi: 10.1093/fampra/cmr025 PubMedCrossRefGoogle Scholar
  12. 12.
    Navaratnam P, Jayawant SS, Pedersen CA, Balkrishnan R (2008) Physician adherence to the national asthma prescribing guidelines: evidence from national outpatient survey data in the United States. Ann Allergy Asthma Immunol 100(3):216–221. doi: 10.1016/S1081-1206(10)60445-0 PubMedCrossRefGoogle Scholar
  13. 13.
    Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, Fabunmi RP, Kwan J, Mills T, Simpson SL (2005) National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation 111(4):499–510. doi: 10.1161/01.CIR.0000154568.43333.82 PubMedCrossRefGoogle Scholar
  14. 14.
    Bes-Rastrollo M, Sabate J, Jaceldo-Siegl K, Fraser GE (2011) Validation of self-reported anthropometrics in the Adventist Health Study 2. BMC Publ Health 11:213. doi: 10.1186/1471-2458-11-213 CrossRefGoogle Scholar
  15. 15.
    Cartsos VM, Zhu S, Zavras AI (2008) Bisphosphonate use and the risk of adverse jaw outcomes: a medical claims study of 714,217 people. J Am Dent Assoc 139(1):23–30PubMedCrossRefGoogle Scholar
  16. 16.
    Zhang J, Saag KG, Curtis JR (2011) Long-term safety concerns of antiresorptive therapy. Rheum Dis Clin North Am 37(3):387–400. doi: 10.1016/j.rdc.2011.08.001 PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • J. Zhang
    • 1
  • E. Delzell
    • 1
  • J. R. Curtis
    • 2
  • F. Hooven
    • 3
  • S. H. Gehlbach
    • 3
  • F. A. AndersonJr.
    • 3
  • K. G. Saag
    • 2
    Email author
  1. 1.Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Clinical Immunology and RheumatologyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Center for Outcomes ResearchUniversity of Massachusetts Medical SchoolWorcesterUSA

Personalised recommendations