More than half of all women will suffer a fracture due to osteoporosis (loss of bone mass) in their lifetime. In a recent study supported by the Agency for Healthcare Research and Quality (HS13013), only 46 percent of older women with osteoporosis-related fractures received treatment in the 6 months following a fracture to prevent further fractures as called for by clinical guidelines. Guidelines call for bone mineral density testing to detect bone loss and, when needed, medication to treat osteoporosis.
Practice lagged behind recommended guidelines even though physicians had access to external guidelines and the HMO's internal Web-based osteoporosis guidelines, notes Adrianne C. Feldstein, M.D., M.S. To characterize the gap between osteoporosis guidelines and practice, Dr. Feldstein and her colleagues at the Kaiser Permanente Center for Health Research studied administrative databases and medical records of 3,812 women average age of 71. The women were enrolled in an HMO and had been diagnosed with a new fracture from 1998 to 2001.
Fewer than 12 percent of the women were diagnosed with osteoporosis prior to the fracture, even though nearly 11 percent had conditions (for example, hyperthyroidism or chronic renal failure) or were taking medications (for example, long-term use of steroids or anticonvulsants) that would put them at risk for developing osteoporosis. In addition, more than one-third (39 percent) of these women were already at increased risk for falling due to medical problems (for example, stroke and dementia) or medication (such as long-acting benzodiazepines or tricyclic antidepressants). Finally, physician adherence to osteoporosis guidelines did not significantly improve from 1998 to 2001.
See "Older women with fractures: Patients falling through the cracks of guideline-recommended osteoporosis screening and treatment," by Dr. Feldstein, Gregory A. Nichols, Ph.D., Patricia J. Elmer, Ph.D., M.S., and others, in the December 2003 Journal of Bone and Joint Surgery 85-A(12), pp. 2294-2302.
Editor's Note: Another AHRQ-supported study on a related topic shows that women who suffer from a major traumatic injury are more likely than men to have poor quality of life following the trauma. For more details, see Holbrook, T., and Hoyt, D.B. (2004, February). "The impact of major trauma: Quality-of-life outcomes are worse in women than in men, independent of mechanism and injury severity" (AHRQ grant HS07611). Journal of Trauma Injury, Infection, and Critical Care 56(2), pp. 284-290.