Abstract
Summary
Osteoporosis treatment initiation was assessed during the year after baseline BMD testing in 8,689 previously untreated women. Treatment initiation increased progressively as BMD T-scores decreased, but there was a gradient response rather than step increases at conventional T-score intervention thresholds.
Introduction
Bone mineral density (BMD) testing is used to identify those at high fracture risk and guide osteoporosis treatment (OTx) initiation. Clinical guidelines have used the World Health Organization T-score diagnostic cutoffs as thresholds for treatment intervention. Our objective was to assess whether OTx initiation tracks these T-score cutoffs.
Methods
Eight thousand six hundred and eighty-nine women age ≥50 years who had not been dispensed any OTx medication in the year prior to baseline BMD were identified from a regionally based database in the Province of Manitoba, Canada, and OTx initiation rates were analyzed.
Results
Forty-four percent of women were dispensed OTx in the year after BMD. OTx initiation increased progressively as BMD T-scores decreased (8.2% normal, 41.0% osteopenic, 78.5% osteoporotic, p-for-trend < 0.0001). There was a gradient response to OTx initiation, rather than step increases at conventional T-score intervention thresholds. BMD was strongly associated with OTx (p < 0.0001) while age, weight, and fracture in the last year were not.
Conclusions
Physicians rely heavily on BMD T-score to decide on OTx initiation. Although guidelines suggest using clinical risk factors to guide decision making, we did not see evidence of this. More explicit methods of reporting fracture risk may help physicians select patients who are likely to derive the largest benefit from OTx.
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Acknowledgments
We are indebted to Manitoba Health and Healthy Living for providing data (File No. 2007/2008-33), Charles Burchill for assistance with data extraction, and Drs. Patricia Caetano and Lisa Lix for advice on the analysis. The results and conclusions are those of the authors, and no official endorsement by Manitoba Health and Healthy Living is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.
Funding
Funded in part by an unrestricted educational grant from the CHAR/GE Healthcare Development Awards Programme
Conflicts of interest
William D. Leslie: In the past 5 years W.D.L. has received speaker fees, research honoraria, and unrestricted research grants from Merck Frosst Canada Ltd.; research honoraria and unrestricted educational grants from The Alliance for Better Bone Health: Sanofi-Aventis and Procter & Gamble Pharmaceuticals Canada, Inc.; unrestricted research grants from Amgen Pharmaceuticals Canada, Inc.; unrestricted educational grants from Genzyme Canada.
All other authors have no disclosures.
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Cranney, A., Tsang, J.F. & Leslie, W.D. Factors predicting osteoporosis treatment initiation in a regionally based cohort. Osteoporos Int 20, 1621–1625 (2009). https://doi.org/10.1007/s00198-008-0823-8
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DOI: https://doi.org/10.1007/s00198-008-0823-8