Guidelines Target Osteoporosis Treatment

The first guidelines advising doctors just who should undergo osteoporosis screening and how patients should be treated have been released by a consortium of nongovernment health organizations.

Although they are only recommendations, the guidelines should help doctors meet the highest standards for the prevention, diagnosis and treatment of osteoporosis, says Molly Natchipolsky of the National Osteoporosis Foundation, which released the document last week in conjunction with several other groups, including the American Academy of Orthopaedic Surgeons and American College of Obstetrics and Gynecology.

“This will be useful for physicians especially on when to recommend bone density screening,” said Natchipolsky. “There seems to be [confusion] in terms of who should be tested, when they should be tested and how the results of tests should be interpreted.”

Osteoporosis, which is a weakening of bones that can lead to fractures, affects one in two women 50 and older. Surveys, however, indicate that about 71% of women with the disease are not diagnosed and 86% are not receiving treatment.

The guidelines are intended for physicians and are not meant to govern health policy decisions about reimbursement or the availability of services, said National Osteoporosis Foundation officials. However, the guidelines should “complement” the Medicare regulations regarding screening and treatment, Natchipolsky said.

Guidelines geared to patients are expected to be published next year, she said. However, consumers can now ask their physicians if they have read the National Osteoporosis Foundation recommendations and if they adhere to them.

Here is a synopsis of the major recommendations to doctors:

* Counsel all women on the risk factors for osteoporosis. Osteoporosis is a “silent” risk factor for fracture just as hypertension is for stroke; one out of two white women will experience an osteoporotic fracture at some point in her lifetime.

* Perform evaluation for osteoporosis on all post-menopausal women with fractures, using bone mineral density (BMD) testing to confirm the diagnosis and determine severity.

* Recommend BMD testing to post-menopausal women under 65 who have one or more additional risk factors for osteoporosis besides menopause (including low calcium intake, smoking, low body weight, alcoholism, estrogen deficiency, inadequate physical activity, etc.).

* Recommend BMD testing to all women 65 and older regardless of additional risk factors.

* Advise all patients to obtain an adequate intake of dietary calcium (at least 1,200 milligrams per day, including supplements if necessary) and vitamin D (400 to 800 IU per day) for individuals at risk of deficiency.

* Recommend regular weight-bearing and muscle-strengthening exercise to reduce the risk of falls and fractures.

* Advise patients to avoid smoking and keep alcohol intake moderate.

* Consider all post-menopausal women who have vertebral or hip fractures as candidates for osteoporosis treatment.

* Initiate therapy to reduce fracture risk in women with BMD T-scores below -2 in the absence of risk factors and in women with T-scores below -1.5 if other risk factors are present. (T-score is expressed by comparing the bone mineral density of the patient to that of a normal young woman when bone mass is at its peak. A T-score of -1 to -2.5 would indicate low bone mass; a T-score of -2.5 or below indicates established osteoporosis.)

* Medications to use for osteoporosis prevention and / or treatment are hormone replacement therapy, alendronate, raloxifene (prevention only) and calcitonin (treatment only).

Consumers can receive a fact sheet and a copy of the guidelines by calling the National Osteoporosis Foundation at (800) 400-1079. Doctors may call the same number for a copy of the guidelines.