Just one-third of women older than 65 years were screened for osteoporosis at an internal medicine clinic, and one-third of those diagnosed were untreated, noted a speaker at the 2021 North American Young Rheumatology Investigator Forum.

“About 10.2 million people in the U.S. have osteoporosis, 30% of all postmenopausal women have osteoporosis in the U.S., about 250,000 people aged 65 years and older are hospitalized for hip fractures every year, and mortality after a hip fracture is about 20% to 30% in the first year,” Shristi Khanal, MD, of the Jefferson Abington Hospital internal medicine department, in Abington, Pennsylvania, told attendees at the forum. “About 50% of patients never return to their previous functional baseline capacity and 33% require long-term care.”

“Osteoporosis itself is asymptomatic and preventing osteoporotic fractures is the main goal of any osteoporosis screening strategy,” she added. “And in the absence of a fragility fracture, bone mineral density assessment by [dual-energy X-ray absorptiometry (DXA)] scan is the standard test to diagnose osteoporosis. The [U.S. Preventive Services Task Force] recommends that women aged 65 and older, or postmenopausal women younger than 65 years, who are at increased risk of osteoporosis, which is determined by formal clinical risk assessment tools like FRAX scores, have routine bone density testing for osteoporosis screening.”

To identify the burden of osteoporosis screening nonadherence among women aged older than 65 years, as well as the factors and complications related to screening and medication nonadherence, Khanal and colleagues at Jefferson Abington Hospital conducted a retrospective single-center chart review of patients at their internal medicine clinic. The study included 200 women with a mean age of 71.5 years, seen at the clinic from January 2017 to April 2020.

Data for this study were reported as percentages for categorical variables, and mean standard deviation, median and interquartile ranges were calculated for continuous variables, Khanal said.

According to the researchers, 33.5% of the included patients received a DXA scan as part of their osteoporosis screening. Among those who received a DXA scan, 32.8% had osteoporosis and 55.2% had osteopenia — just 11.9% demonstrated normal bone density. In addition, 11.5% of the total study population were found to have fragility fractures.

“This was very interesting,” Khanal said.

Among those with fragility fractures, 47.8% received a DXA scan.

Regarding treatment, 36.4% of those diagnosed with osteoporosis were untreated, receiving neither bisphosphonates nor any other recommended medications. However, 81.1% were receiving vitamin D and calcium therapy. Meanwhile, just 54.1% of patients diagnosed with osteopenia were receiving vitamin D and calcium. Lastly, only 18% of patients with fragility fractures received appropriate treatment for osteoporosis, while 47.8% were receiving vitamin D and calcium.

“We can clearly state that osteoporosis screening with DXA scan is underutilized,” Khanal said. “Almost half of the patients diagnosed with osteoporosis or osteopenia were not receiving guidelines-recommended therapy, and most of the patients with fragility fractures were not receiving treatment for osteoporosis. To decrease the mortality and morbidity related to osteoporosis, it is important to improve the screening rate.

“For that, it is important to streamline the screening process and eliminate barriers, promote education of providers on the importance of screening for osteoporosis, just like mammogram and hyperlipidemia screening, and increased public health awareness,” she added. “And not just the screening: It’s important to promote education of providers on role of bisphosphonates and other medications for osteoporosis so that they have different options based on patient profile. Last but not the least, it is important to emphasize on starting osteoporosis treatment immediately for fragility fractures.”