Press Releases: National
December 26, 2003
Majority of older women with fractures not receiving recommended testing and treatment for osteoporosis
Portland, Ore. – National guidelines for evaluating and treating osteoporosis were first published in 1996. Since then, several studies have found a substantial gap between guideline recommendations and actual clinical practice. A new study, conducted by researchers at Kaiser Permanente's Center for Health Research (CHR), shows that nearly 54 percent of older women who suffered a fracture—a strong indicator of osteoporosis—were not evaluated or treated for osteoporosis. The study also found important differences between women who did and did not receive treatment that may help researchers and clinicians design more effective ways to prevent future fractures. Results of the study, funded by the Agency for Healthcare Research and Quality, appear in the December 2003 issue of The Journal of Bone and Joint Surgery.
"We conducted this study to identify the gaps between osteoporosis guidelines and actual clinical practice," says Adrianne Feldstein, MD, MS, lead author and assistant medical liaison for research and adjunct investigator at CHR. "This kind of information is needed so researchers, clinicians, and health systems can design improved systems of care. Based on this information, we have designed and conducted a clinical intervention study to prevent re-fractures in older women. Results of that study will be available in mid-2004."
National guidelines recommend that older women with fractures should either receive medications for osteoporosis if the condition is apparent, or they should have a bone mineral density (BMD) measurement, followed by medication treatment if indicated. In this study of 3,812 women age 50 and over who had a new fracture diagnosed between January 1998 and July 2001, more than 95 percent did not receive a BMD measurement and nearly 55 percent did not receive a medication for osteoporosis. During the study period, clinicians who treated these patients had access both to external and internal Web-based clinical guidelines for evaluating and treating osteoporosis.
"Simply providing physicians with clinical guidelines is not enough to change clinical practice," says Dr. Feldstein. "The gap between guidelines and actual clinical practice means we need to find other ways to improve clinician and patient education and to facilitate action. Successful strategies in other clinical areas have included academic detailing, computer alerts and reminders, and improved systems of care. For example, orthopedists who treat older women for fractures could help reduce the gap either by referring patients to their primary care physicians for evaluation or by initiating BMD measurements and then referring patients for treatment."
The study found a number of important differences between women who did and did not receive evaluation and treatment. Compared to women who received recommended care, women who did not receive evaluation or treatment were older; weighed less; and had more fractures of the hip, wrist, and humerus. Women who received recommended care were more likely to have had fractures of the spine and to take steroid medication chronically.
"The bottom line for both clinicians and older women patients," Dr. Feldstein says, "is that they should view a fracture as possibly indicating osteoporosis until proven otherwise. Simply having a low-impact fracture should trigger evaluation and treatment."
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
