With current estimates suggesting that a plateau in the rates of hip fractures and a decrease in the rates of testing, diagnosis, and treatment of high-risk patients with osteoporosis, experts from more than 30 national and international societies have issued a call to action to address what they say is a “crisis in the treatment of osteoporosis.”1,2

“We have a crisis not only in this country but around the world because we are not adequately treating osteoporosis,” Douglas P. Kiel, MD, MPH, president of the American Society for Bone and Mineral Research (ASBMR), said during a press conference at the ASBMR 2016 Annual Meeting. 

“We must take action to aggressively reduce this burgeoning fracture risk in our aging population. … Acknowledging this crisis, 34 organizations have come together to sign this call to action, [pledging] to intensify their current effort to increase screening, diagnosis and treatment of high-risk individuals to prevent fractures.”


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Key Changes Highlighted

At the press conference, Kenneth Saag, MD, president of the National Osteoporosis Foundation (NOF), co-chair of the National Bone Health Alliance, and Rheumatology Advisor advisory board member, went into detail on the recent changes that have led to this crisis in osteoporosis treatment: the declines in medication use and dual-energy X-ray absorptiometry (DXA) testing; and the plateauing rate of hip fractures.

According to Dr Saag, the declines in DXA testing are associated with the 70% reduction in the reimbursement for these tests, which has been prohibitive for many physicians, while current data for medication use has shown that half as many people are taking treatment as they were in the mid-2000s. Furthermore, the 30-year decline in hip fractures in the United States has plateaued in the last few years.3

“The benefit we saw, potentially attributed to the aggressive management of osteoporosis, in years past has evaporated,” Dr Saag said. “While we can’t prove a causal relationship of less testing and treatment with the plateauing in a previously declining rate of fractures, these trends are extremely concerning and highlight a new crisis in our management of osteoporosis.”

And the consequences for patients who experience fracture, Dr Saag stressed, are dire.

“For hip fractures alone,” he said, “there is a 25% mortality in the first year after the event; 50% of survivors are permanently incapacitated; and hip fracture patients are over 2-fold more likely than their peers to become financially destitute.”1,4

Survey Finds Chief Concerns With Osteoporosis

To better understand this crisis from the patient and caregiver perspective, the NOF recently conducted a survey, results of which were presented at the ASBMR 2016 Annual Meeting and highlight the primary concerns with osteoporosis from members of the NOF’s online community.

For the survey, 853 individuals responded, of whom 71% had osteoporosis; 93% were women; 72% were aged between 56 and 74 years; and 94% were white.5

Among patients with osteoporosis, the chief concern with aging was loss of independence (42%), followed by loss of mobility (25%), cost of health care (14%) and breaking a bone/fractures (10%).5 On the other hand, the biggest concern for caregivers of osteoporosis patients was being unable to manage the care of their patient or loved one (50%).5

In other survey data, 52% of patients said they had broken a bone (mean number of broken bones, 3), yet 44% said they were only somewhat or not concerned about fracturing again.5 Meanwhile, 60% of those who had broken a bone were not referred for a bone density test after the fracture and only 47% were prescribed an osteoporosis medication.5

In light of these findings, Andrea Singer, MD, medical director of NOF, said during the press conference, “We clearly still have a lot to do when it comes to educating our patients and putting benefit-risk, or perhaps risk-risk, in perspective.”

Call for Change

Going forward, experts from the 34 medical societies have pledged to intensify their present efforts and collaborate on new opportunities to increase the screening, diagnosis, and treatment of high-risk individuals to prevent fractures. They will also be partnering with patients to make informed choices about osteoporosis treatment options.

In addition, the societies are calling for the following:

  • Health professional education programs and continuing medical education programs to expand education
  • Governmental organizations to increase focus and support for programs to reach the highest-risk patients
  • Insurers (private and public) to cover the most effective services
  • Health systems and medical practices to adopt and use quality measures

“We are calling on everyone to recognize this crisis in osteoporosis treatment and the challenges that are faced by patients and their physicians,” Dr Kiel said. “As we move forward in this call to action, we need to keep at the forefront of our minds and actions our patients and their families, and do everything we can to reduce their risks for debilitating fractures.”

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References

  1. Press briefing: New research on osteoporosis treatment crisis. Presented at: ASBMR 2016 Annual Meeting; September 16-19, 2016; Atlanta, Georgia.
  2. American Society for Bone and Mineral Research, American Academy of Orthopaedic Surgeons, American Academy of Physician Assistants, et al. Call to action to address the crisis in the treatment of osteoporosis. September 19, 2016.
  3. Lewiecki EM, Adler R, Curtis J, et al. Abstract 1077. Hip fractures and declining DXA testing: At a breaking point? Presented at: ASBMR 2016 Annual Meeting; September 16-19, 2016; Atlanta, Georgia.
  4. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005- 2025. J Bone Miner Res. 2007;22(3):465-475. doi:10.1359/jbmr.061113.
  5. Loss of independence ranks as osteoporosis patients’ greatest concern about aging, according to recent survey by NOF [press release]. Arlington, VA: National Osteoporosis Foundation; September 21, 2016. https://www.nof.org/news/loss-independence-ranks-osteoporosis-patients-greatest-concern-aging-according-recent-survey-nof.. Accessed September 24, 2016.

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This article originally appeared on Endocrinology Advisor