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Undertreatment of osteoporosis in women, based on detection of vertebral compression fractures on chest radiography.
BACKGROUND: Fractures attributable to ostcoporosis are responsible for preventable suffering and health care costs. Until they experience a fracture, many older adults, particularly women, are unaware that they have osteoporosis. Although radiographs taken for reasons other than evaluating the possibility of osteoporosis may suggest the presence of fracture, such fractures often go undetected and effective treatments are not implemented.
OBJECTIVE: The goal of this study was to determine the adequacy of treatment of osteoporotic vertebral compression fractures in middle-aged and older women in an internal medicine clinic, as ascertained by reports of chest radiography. The hypothesis was that patients having chest radiographs with observable vertebral compression fractures often did not receive adequate treatment.
METHODS: This was a retrospective, cross-sectional study conducted at a general internal medicine clinic at a university-affiliated county hospital. The records of an academic internal medicine practice were searched to identify women aged >or=40 years with radiologic evidence of vertebral compression fractures during the period from June 1, 1992, through May 31, 2002. Electronic prescription records were then searched to determine whether patients had received a prescription for a medication for the treatment of osteoporosis. An analysis also was conducted to describe the frequency distribution of various medications for the treatment of osteoporosis.
RESULTS: One hundred thirteen women were identified who met the study criteria. Their mean (SD) age was 68.1 (21.9) years. Fifty-six (50%) of these women received pharmacologic treatment for osteoporosis. The most commonly prescribed medications were estrogens (35%), calcitonin (16%), and bisphosphonates (12%).
CONCLUSIONS: No more than half of patients identified as having a vertebral compression fracture on chest radiography received even 1 prescription for the treatment of osteoporosis. Because this study did not examine adherence or long-term medication use, the proportion of women who received adequate osteoporosis therapy was probably much less than half. Physicians should be alert to the possible presence of vertebral compression fractures and take a more aggressive approach to treatment when a fracture is present.