Crisis in the treatment of osteoporosis

Sundeep Khosla, MD, a practicing endocrinologist, research scientist, professor of medicine and director of the Clinical and Translational Science Award Program at the Mayo Clinic in Rochester, Minnesota, and Elizabeth Shane, MD, a practicing endocrinologist, research scientist, professor of medicine and vice chair for clinical and epidemiological research at Columbia University in New York explain in their article A Crisis in the Treatment of Osteoporosis that too many patients at high risk for fractures are not being diagnosed or treated to prevent them. They summarize evidence that shows that high-risk patients are not getting appropriate therapy despite research showing the effectiveness of several osteoporosis drugs in preventing fractures. Khosla and Shane also outline how the field arrived at its current situation, citing research analyzing parallel trends in media and public concern about rare side effects with a decline in the use of osteoporosis drug prescriptions and an increase in hip fractures.

The authors state: "While there are certainly controversies in the field of osteoporosis, there are also issues upon which there is complete or near-complete agreement: specifically, there is consensus that patients with hip fracture should receive pharmacological treatment to prevent additional fractures, as they are clearly at risk for recurrent hip or other osteoporotic fractures, and initiation of bisphosphonate therapy after hip fracture has been shown to reduce the risk of a second hip fracture."

"We should be viewing the future for our patients with osteoporosis with unparalleled optimism, because we now have several drugs that can markedly reduce fracture incidence, by as much as 70% in the case of vertebral fractures. Thus, while physicians still struggle to treat many other conditions that are currently intractable, including Alzheimer's and many cancers, the good news is that the prevention of fractures is clearly within our reach. And yet, despite the development of several effective drugs to prevent fractures, many patients, even those who unequivocally need treatment, are either not being prescribed osteoporosis medications at all, or when prescribed, refuse to take them."

Nearly 65 percent of people in the United States who are 65 years old and older have osteoporosis or low bone mass and are at risk for a fracture, according to data from the Centers for Disease Control and with an aging population , the prevalence of the disease is projected to rise. Data collected by the National Committee for Quality Assurance show that currently only 25 percent of patients who suffer a fracture are treated. Meanwhile, hip fracture patients' use of osteoporosis medications following fracture decreased from 15 percent to 3 percent between 2004 and 2013.