If Screening Shows Osteoporosis, Many Women May Not Tell Their Physician or Begin Treatment, UB Study Finds

PALM DESERT, Calif. -- Osteoporosis, a disease of bone-thinning that puts women at risk of serious fractures, is underdiagnosed and undertreated, a study by University at Buffalo researchers presented today at the annual meeting of the Society for Epidemiological Research has found.

Nearly half of 836 women in a population-based study who underwent screening for osteoporosis for the first-time were found to have undiagnosed disease, results showed. Moreover, follow-up a year later revealed that half of those diagnosed with osteoporosis did not begin treatment to slow progression of the disorder and a quarter failed to discuss the screening results with their physician.

"This study tells us there are a lot of women with osteoporosis who don't know it," said Jean Wactawski-Wende, Ph.D., UB assistant professor of social and preventive medicine and obstetrics and gynecology and senior researcher on the study.

"Many women who are at risk for osteoporosis are not being referred for screening, and even when screened, only half of those found to have osteoporosis end up receiving therapy," she said. "We have a long way to go in educating women and their physicians about osteoporosis."

The results were presented in a poster session at the meeting.

Osteoporosis is a serious health condition, associated primarily with aging, in which bones lose mass and become brittle, breaking easily. Postmenopausal women of northern-European heritage are affected most frequently, although men and women of all ethnic backgrounds may become osteoporotic. Eight million women and two million men in the U.S. are estimated to have osteoporosis, and an estimated 34 million more people have low bone density, according to the National Osteoporosis Foundation (NOF).

Osteoporosis can affect any bone, but hip and spine fractures cause the most serious health consequences. A broken hip almost always requires major surgery and a lengthy hospital stay. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal fractures can result in severe back pain, loss of height and the spinal deformity often referred to as "dowager's hump," abnormal curvature of the spine resulting from collapse of the spinal column that produces a rounded hump in the upper back.

The best method to determine if a person has osteoporosis is a dual-energy x-ray absorptiometry (DXA) scan, which can assesses the bone mineral density at any particular site in the body and compute a comparison with the established optimum density for that site.

The current research, an ancillary study of the Women's Health Initiative, for which UB is a vanguard clinical center, was designed to find out what factors would influence a woman's decision to begin therapy after being diagnosed with osteoporosis through DXA screening. The study group was composed of 836 Caucasian women between the ages of 58 and 90 in Western New York who were being assessed for the association between osteoporosis and periodontal disease. None of the women had been diagnosed previously with osteoporosis or had undergone bone density testing.

Of the total screened, 428 were found to have bone density at least two standard deviations below the norm, the definition of osteoporosis adopted by the NOF in a general population at normal risk. All participants received an explanation of the screening results and instructions to discuss the results with their physician. They were recontacted by mail after one year to find out how many had begun treatment. (Five drugs for osteoporosis have been approved by the FDA; all work by helping to stop the resorption of bone minerals by other cells in the body.)

Results showed that 307 of those diagnosed with osteoporosis had discussed the results with their physician, as instructed. Wactawski-Wende said the researchers waited a full year before following up to give the women plenty of time to have a routine doctor's visit. Of those who did talk to their doctors about their condition, only 167 of osteoporotic women, or about 54 percent, began treatment.

When factors that might influence therapy were analyzed singly, results showed that women who began treatment were more likely to have lower bone mineral density scores, indicating the condition was at a more advanced stage; visit the doctor more then once a year, and be thinner and better educated than those who didn't begin treatment.

When all factors were analyzed together, the variables most strongly associated with treatment were low bone density and higher education, Wactawski-Wende said.

Part of this on-going research project will be to determine the most effective ways to educate both doctors and the community about the importance of routine bone density screening and of taking appropriate medications and preventive measures to slow the process if osteoporosis is diagnosed.

Renee M. Brennan, UB graduate student in the Department of Social and Preventive Medicine is first author on the study. Additional contributors were Carlos J. Crespo, Dr.PH, UB associate professor of social and preventive medicine and Jacek Dmochowski, Ph.D., UB assistant professor of statistics.

The research was supported in part by a grant from the Department of the Army Medical Defense Fund and a contract from the National Institutes of Health.