Millions of osteoporosis sufferers go undiagnosed, Stanford study finds

STANFORD, Calif. – Despite recent gains in the awareness and treatment of osteoporosis, millions of Americans who have the disease remain undiagnosed and untreated and may learn of their condition only when they suffer a fracture, Stanford University School of Medicine researchers report.

Writing in the July 26 issue of Archives of Internal Medicine, the research group estimates that fewer than half of the people with osteoporosis have been recognized as such. “If a person’s doctor hasn’t diagnosed osteoporosis, there’s no way they could be on optimal treatment for their bone condition,” said Randall Stafford, MD, PhD, assistant professor of medicine in the Stanford Prevention Research Center, who led the study.

Osteoporosis is a disease in which bones become more fragile and prone to break. The study found that 3.5 million patients visited their doctors last year for osteoporosis treatment, compared with just half a million in 1994. For these patients, new prescription medications provide easier and more effective treatments than were available in the past. As encouraging as this progress is, much still needs to be done to identify and treat people with the disease, the report notes.

About 10 million Americans have osteoporosis and 34 million more are at risk, but the weak bones that characterize the condition often go unnoticed until they fracture, most frequently in the hip, spine or wrist. Among the older people (mainly women) most susceptible to osteoporosis, this can present major problems. “The gravity of fractures is often underappreciated when in fact patients with hip fractures go on to have deterioration in their health linked directly to their fractures, with a high probability of death or nursing home placement,” Stafford said.

In 2001, the direct medical costs of osteoporosis were about $17 billion. Despite this, it was not until 2002 that the U.S. Preventive Services Task Force began recommending that all women over age 65 be screened for low bone density.

Both recognition and treatment of osteoporosis have increased noticeably in the past 10 years, the research group found. Stafford attributes this to a constellation of factors, including the emergence of new drugs, more marketing of medications, increased public awareness and better screening technology.

One cause for concern, Stafford said, is that as prescriptions for newer anti-osteoporosis drugs have increased, the use of calcium supplements has decreased. Doctors reported treating 43 percent of osteoporosis patients with calcium supplements in 1994, but only 24 percent last year. “Physicians and patients may be so enamored of the new drugs that they are neglecting this important component of osteoporosis treatment,” Stafford said. This would be a mistake, he noted, because newer osteoporosis medications were tested on people taking extra calcium and may not work as well without it.

The results of the study, which used data from an ongoing national physician survey, also point to a path to increase the diagnosis and treatment of osteoporosis. Since most osteoporosis is recognized and treated by primary care physicians, these physicians are the best targets for improvement efforts, Stafford said. “It’s not a matter of the knowledge being out there, but it’s a matter of the knowledge being implemented by the physicians who are providing most of the care,” he explained.

Research group member Rebecca Drieling, project business manager, said the importance of treating osteoporosis will only increase. “We have an aging population, so we need to be prepared now to educate physicians and the public to follow the guidelines that recommend that every woman over the age of 65 have bone mineral density screening so that we can catch osteoporosis cases early,” she said.

Adam Hersh, MD, PhD, a former Stanford postdoctoral scholar, also assisted with the study. The study was supported by a grant from the Agency for Healthcare Research and Quality.