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Missed opportunities in osteoporosis treatment: possible gender bias?
Submit responseTO THE EDITOR: The study by Majumdar and colleagues (1) illustrates a potential solution to the problem of missed opportunities toward osteoporosis treatment in patients with fragility fractures. The authors observed that even though their multifaceted intervention of faxed physician reminders and patient education tripled the rate of bone mineral density testing and osteoporosis treatment, less than half of the intervention patients received antiresorptive therapy, and 49% did not use either calcium or vitamin D supplements. It would be of interest to note the proportion of men who received bone mineral density testing and subsequent osteoporosis treatment compared to women. It is possible that in clinical practice, some of the “clinical inertia” toward osteoporosis treatment may stem from the lack of currently available therapeutic guidelines specifically addressing osteoporosis detection and treatment in men. We observed that in men aged 50 and above who were admitted for fragility fractures of the hip, only 14% subsequently underwent outpatient bone mineral density testing, and 5 out of 52 were prescribed antiresorptive therapy, either calcitonin or bisphosphonate (2). Also, less than 20% had documented calcium and vitamin D supplementation. We found that men who underwent bone mineral density testing were treated more aggressively for osteoporosis, suggesting that confirmation of osteoporosis by bone mineral density testing may be associated with higher treatment rates. Osteoporosis is often underdiagnosed in hip fracture patients, but those who are diagnosed are more likely to be discharged on osteoporosis medications (3). Tertiary prevention in osteoporosis involves identification and targeted treatment of all older patients with a history of fragility fracture regardless of gender. This “clinical inertia” needs to be overcome in the same fashion as treatment of heart disease, which does not discriminate in old age.
References
1. Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, et al. A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med. 2004;141:366-73. [PMID: 15353428]
2: Lim LS, Takahashi PY. Osteoporosis intervention in men with hip fracture. Age Ageing. 2004;33:507-8. [PMID: 15315922]
3: Bahl S, Coates PS, Greenspan SL. The management of osteoporosis following hip fracture: have we improved our care? Osteoporos Int. 2003;14:884-8. [PMID: 14569422]
Conflict of Interest:
None declared