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Title: The diagnostic threshold for osteoporosis impedes fracture prevention in women at high risk for fracture: A registry-based cohort study.
Austin Authors: Leslie, William D;Seeman, Ego ;Morin, Suzanne N;Lix, Lisa M;Majumdar, Sumit R
Affiliation: Dept. of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Department of Endocrinology and Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
Dept. of Medicine, McGill University, Montreal, Canada
Dept. of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Department of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
Issue Date: Sep-2018 2018-07-06
Publication information: Bone 2018; 114: 298-303
Abstract: The diagnostic threshold for osteoporosis, a bone mineral density (BMD) T-score ≤ -2.5, signals an increased risk for fracture. However, most fragility fractures arise among the majority of women with 'osteopenia' or 'normal' BMD. We hypothesized that a BMD T-score of -2.5, even if not intended as a treatment threshold, paradoxically may create disincentive to initiating treatment of women with osteopenia or normal BMD at high risk for fracture. From a population-based BMD registry covering the Province of Manitoba, Canada, we identified 3735 untreated women aged ≥ 50 years undergoing BMD screening in 2006-2015 found to qualify for Osteoporosis Canada guidelines-based treatment. The main outcome was prescription of an approved osteoporosis medications in the year after BMD testing ascertained from a population-based pharmacy database. We estimated adjusted odds ratios (OR, 95% confidence interval [CI]) for treatment initiation based on BMD, major fracture history (non-traumatic vertebral, hip or multiple fractures), age, and calendar year (to examine the impact of treatment guidelines published in 2010). Among these women, 50% (1853) initiated treatment: 71% with osteoporosis, 21% with osteopenia, and 5% with normal BMD with similar values in those with a prior major fracture (71%, 19%, 5%, respectively). Compared to women with osteoporosis, adjusted ORs for treatment of high risk women with osteopenia or normal BMD alone were 0.10 (95% CI 0.09-0.12) and 0.02 (95% CI 0.01-0.04), respectively, and no higher in women with a prior major fracture (OR 1.00, 95% CI 0.84-1.19) or following introduction of treatment guidelines (p = 0.294). In summary, we found evidence that the diagnostic threshold for osteoporosis may serve as a disincentive to initiation of treatment in many women at high risk for incident fracture.
DOI: 10.1016/j.bone.2018.07.004
ORCID: 0000-0002-9692-048X
PubMed URL: 30008396
Type: Journal Article
Subjects: DXA
Fracture prevention
Fracture risk assessment
General population studies
Health services research
Appears in Collections:Journal articles

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