PHILADELPHIA — More physicians are using bone mineral density measurements and biochemical marker testing to identify and treat osteoporosis, according to data from a national survey.
More than 200,000 postmenopausal, nonosteoporotic women were enrolled in the National Osteoporosis Risk Assessment (NORA) in September 1997. In conjunction with the study, 2,836 referring primary care physicians completed a baseline survey in 1998 that tested their knowledge of osteoporosis screening and treatment. In 2006, 808 of these providers responded to a follow-up survey designed to assess changes in their practice patterns and knowledge of the condition, Dr. Paul D. Miller reported in a poster at the annual meeting of the American Society for Bone and Mineral Research.
The number of physicians who reported frequent use of bone mineral density (BMD) measurements to screen for, diagnose, or monitor osteoporosis more than doubled between 1998 and 2006—from 35% to 87%. More impressively, the number of physicians who reported sometimes or often using biochemical marker testing to screen for, diagnose, or monitor osteoporosis almost tripled—from 19% to 54%, wrote Dr. Miller, medical director of the Colorado Center for Bone Research and a professor at the University of Colorado Health Sciences Center in Denver.
In the same period, the percentage of physicians who knew that a bone mineral density T score of −2.5 or less was the threshold indicating the presence of osteoporosis almost doubled, from 34% to 67%.
However, the percentage of physicians who knew the threshold value requiring pharmacologic intervention (T score of −2.5 or less [according to the World Health Organization] or a T score of −2.0 or less with no risk factors [according to the National Osteoporosis Foundation]) remained the same at 60%.
In terms of changes in treatment, the use of hormone therapy dropped sixfold (67% vs. 11%) from 1998 to 2006. In contrast, bisphosphonate use jumped from 15% to 59%.
Dr. Miller reported that he has received funding and consulting fees from F. Hoffmann-La Roche Ltd. and GlaxoSmithKline.
In a separate analysis of data from NORA, Dr. Ethel S. Siris and her colleagues found that most of the women in the study had a repeat BMD measurement within 6 years of baseline.
As part of NORA, the women had their BMD measured at the heel, forearm, or finger at baseline. At 1, 3, and 6 years, the women were asked about repeat measurements.
Within 3 years of baseline, 29% of the women had a repeat BMD, while 58% had one within 6 years, Dr. Siris of the Toni Stabile Osteoporosis Center at Columbia University Medical Center in New York wrote in a poster.
Women were more likely to have repeat BMD measurements within 6 years of baseline if they were taking an osteoporosis medication (odds ratio 3.22), had talked with their physician about their baseline BMD results (OR 1.41), were taking corticosteroids (OR 1.25), were taking thyroid medication (OR 1.16), or weighed less than 127 pounds (OR 1.14) following multivariate adjustment.
Interestingly, women with a baseline T score of −2.5 or lower were less likely to have a repeat BMD (adjusted OR 0.86), while women with a baseline T score between −1.0 and −2.49 were slightly more likely (adjusted OR 1.12).
This study received funding from Merck & Co. Dr. Siris reported receiving consulting fees from Merck & Co., Procter & Gamble, Eli Lilly and Company, and Pfizer Inc.