Framing the osteoporosis discussion

Some of the latest clinically relevant findings in preventing, diagnosing and treating osteoporosis will be presented this week as the National Osteoporosis Foundation holds its ninth international symposium in Las Vegas.

It looks as if the agenda will cover a wide range of topics: drug therapy, nutrition, communicating with patients about drug side effects, and the emerging science on clinical practice and therapeutic issues related to osteoporosis. The week will wind up with a session co-sponsored by the American Society for Bone and Mineral Research on what’s new in bone research.

I always sort of assumed that most adult Americans know at least a little bit about osteoporosis, or thinning of the bones, a condition that’s often age-related and can increase the risk of fractures. After all, ads for prescription drugs to stave off osteoporosis seem to be everywhere these days. So I was a little surprised when a recent survey, conducted by the National Osteoporosis Foundation and Harris Interactive, found that 34 percent of the respondents had never heard of the condition.

Although 70 percent of the survey participants believed osteoporosis can be prevented, half didn’t know that exercise can make a difference, and almost three-fourths were unaware of the role nutrition can play. (Since I’ve been unable to find any information on how the survey was conducted or how many people participated, take these findings with a slight grain of salt.)

Poor bone health can be a big deal. Individuals with osteoporosis are more vulnerable to breaking a bone, leading to pain, disability, medical expenses and, in the most serious cases, loss of independence and/or shortened lifespan. Some people never truly recover. It’s thought that as many as two out of every 10 older adults who break a hip die within a year, due to problems either associated with the injury itself or the surgery to fix it.

Figuring out the best screening and prevention strategies hasn’t been easy, though. Do we screen everyone past a certain age? How do we identify other at-risk populations? What are the important risk factors? How often should people be screened? How aggressive should we be about prescribing medication to prevent osteoporosis? Which people are the best candidates for medication and how long should they take a drug?

The U.S. Preventive Services Task Force, the main body for developing evidence-based screening guidelines for clinical practice, issued new recommendations back in January on screening for osteoporosis. The gist of the task force’s recommendations: Women who are over age 65 and women who are younger but have the same or higher fracture risk as a white woman over age 65 should be screened.

The panel concluded there was “convincing evidence” that bone density measurement with DXA, or dual-energy X-ray absorptiometry, can effectively predict the short-term risk of a fracture and appears to be more reliable than questionnaire forms of screening. Overall, the USPSTF concluded that for these two populations of women, “there is moderate certainty that the net benefit of screening for osteoporosis by using DXA is at least moderate.”

So what about drug therapy to lower the risk of osteoporosis? Here the evidence becomes rather murky. In a guest essay published online last week at Kevin MD, Dr. Juliet K. Mavromatis notes that she sees many women who “are left on these drugs for years and years,” despite limited clinical knowledge about the long-term safety.

It’s an area that’s ill-defined, she wrote:

Many questions remain about how to approach the treatment of aging bones to prevent the debilitating outcome of bone fracture. Seasoned clinicians have seen the problems that may occur in some cases with treating large populations of well patients for normal life processes (postmenopausal estrogen replacement therapy). Let’s hope that future research will address the question of when to treat with medication and for how long with further precision. Until then let’s use appropriate caution when prescribing medicine for normal senior bones.

The USPSTF recommendations do in fact call for more research on several issues: how often women should be screened for osteoporosis, the extent to which screening truly has an impact on long-term health outcomes, and the impact of osteoporosis on women of color. More studies also need to be designed for men, who can get osteoporosis too although their risk is lower than that of women.

Given the swelling numbers of Americans who are getting older and the likely rise in the number of people with osteoporosis, this seems to be an area of study that calls for some serious attention.

Image: Wikimedia Commons

Don’t forget – live guest-blogging tomorrow with the Willmar Ambulance Service!