Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures

A gap in evidence-based practice guideline implementation

Adrianne Feldstein, Patricia J. Elmer, Eric Orwoll, Michael Herson, Teresa Hillier

Research output: Contribution to journalArticle

167 Citations (Scopus)

Abstract

Background: Osteoporosis evaluation and treatment guidelines state that, because of the high risk for future fractures, a fracture in an older individual warrants initiation of pharmacological treatment or bone mineral density (BMD) measurement followed by treatment according to BMD. We compared current practice with these guidelines. Methods: We used the electronic data systems of a health maintenance organization to collect fracture, BMD measurement, and pharmacy data for women aged 50 to 89 years and men aged 65 to 89 years who sustained a study-defined fracture during 1998 or 1999. We determined those who had BMD measurement or pharmacological treatment for osteoporosis (bisphosphonate or estrogen) during the 2 years. We compared the evaluation and treatment data with evidence-based clinical guidelines (for women) or expert consensus (for men). Results: Of 70513 members in the eligible age groups, 2804 persons sustained study-defined fractures. Overall, only 4.6% of those with fractures had treatment initiated after the fracture. Women sustained 80.7% of the study-defined fractures; 8.4% had BMD measurement and 42.4% received any treatment during the 2 years. Bone mineral density measurement and treatment frequency decrease significantly with age in women. In men, 1.5% had BMD measurement and 2.8% received any treatment. Approximately 51% (51.2%) of women and 95.5% of men in our study population were not evaluated or treated in accord with guideline or expert recommendations. Conclusions: Evaluation and treatment rates for osteoporosis in older individuals with fractures fall far below national recommendations, especially for men. Intervention strategies should be developed and evaluated to prevent refracture in older individuals with fractures.

Original languageEnglish (US)
Pages (from-to)2165-2172
Number of pages8
JournalArchives of Internal Medicine
Volume163
Issue number18
DOIs
StatePublished - Oct 13 2003

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Evidence-Based Practice
Practice Guidelines
Bone Density
Osteoporosis
Therapeutics
Guidelines
Pharmacology
Health Maintenance Organizations
Diphosphonates
Information Systems
Estrogens
Age Groups

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures : A gap in evidence-based practice guideline implementation. / Feldstein, Adrianne; Elmer, Patricia J.; Orwoll, Eric; Herson, Michael; Hillier, Teresa.

In: Archives of Internal Medicine, Vol. 163, No. 18, 13.10.2003, p. 2165-2172.

Research output: Contribution to journalArticle

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