Filling the Cracks between Guidelines and Practice in Osteoporosis

There's a big difference between what should be done for the prevention and treatment of osteoporosis and what's actually being done. This is the first report of a gap between guidelines and current practice in this area.

National guidelines for osteoporosis treatment and prevention are out. They come from the National Osteoporosis Foundation, the American College of Rheumatology, and the American Association of Clinical Endocrinologists. Many clinics make their own standards based on the national listings.

Doctors at the Oregon Kaiser Permanente Center for Health Research in Portland studied a group of 3,812 women in their health maintenance organization. All women were over 50 years of age. All had a fracture within the last six months. They found that less than half the women with fractures were treated by the clinic guidelines for osteoporosis. The guidelines advise measurement of bone mineral density (BMD) and treatment with drugs. Both steps should be done within six months of the fracture.

About 45 percent received drugs for osteoporosis, but most of them were already taking these before their fracture. Only five percent of the women had a BMD study in the 12 months before or six months after the fracture. Three-fourths of the women who did get the drug took it regularly. Younger women were more likely to follow the treatment on a regular basis.

The authors of this study report no change in the way doctors treated osteoporosis at their health care center from 1998 to 2001. They think something needs to be done about the gap between guidelines and practice for osteoporosis. Closing the gap is important as more and more people live longer. Just giving doctors guidelines probably isn't enough. Suggestions include:

  • Look for patients with risk factors linked to fractures.
  • Use electronic medical records to find these patients.
  • Teach at-risk patients the steps to prevent osteoporosis.
  • Tell small groups of doctors about preventing and treating osteoporosis.
  • Remind doctors to send all older patients who've broken a bone for a BMD study.



    References: Adrianne C. Feldstein, MD, MS, et al. Older Women with Fractures: Patients Falling through the Cracks of Guideline-Recommended Osteoporosis Screening and Treatment. In The Journal of Bone and Joint Surgery. December 2003. Vol. 85-A. No. 12. Pp. 2294-2301.

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