Treatment of osteoporosis: Are physicians missing an opportunity?

Background Medical treatment of women with established osteoporosis may dec rease the incidence of future fractures. Postmenopausal women who have sust ained a distal radial fracture have decreased bone-mineral density and near ly twice the risk of a future hip fracture. The purpose of this study was t o evaluate the adequacy of diagnosis and treatment of osteoporosis in postm enopausal women following an acute fracture of the distal part of the radiu s. Methods: A retrospective cohort study was performed with use of a claims da tabase that includes more than three million patients, from thirty states, enrolled in multiple health plans. All women, fifty-five years of age or ol der, who sustained a distal radial fracture between July 1, 1994, and June 30, 1997, were identified in the database. Only patients,vith at least six months of continuous and complete medical and pharmaceutical health-care co verage from the date of the fracture were enrolled, to ensure that all heal th-care claims would be captured in the database. This cohort of patients w as then evaluated to determine the proportion who had undergone either a di agnostic bone-density scan or treatment with any recommended medication for established osteoporosis (estrogen, a bisphosphonate, or calcitonin) withi n six months following the fracture. Results: A search of the database identified 1162 women, fifty-five years o f age or older, who had a distal radial fracture. Of these 1162 patients, t hirty-three (2.8 percent) underwent a bone-density scan and 266 (22.9 perce nt) were treated with at least one of the medications approved for treatmen t of established osteoporosis. Twenty women had both a bone-density scan an d drug treatment, Therefore, only 279 (24.0 percent) of the 1162 women who sustained a distal radial fracture underwent either diagnostic evaluation o r treatment of osteoporosis. There was a significant decrease in the rate o f treatment of osteoporosis with increasing patient age at the time of the fracture (p < 0.0001). Conclusions Current physician practice may be inadequate for the diagnosis and treatment of osteoporosis in postmenopausal women who have sustained a distal radial fracture.