NEW YORK (Reuters Health)—Too many women who aren’t at risk for osteoporosis are being screened for the disease, and too many women who don’t need osteoporosis treatment are getting it, new research suggests.
“In our health system the overtreatment of osteoporosis was common, and this was partly due to the fact that a lot of women were screened who were younger than age 65 and low risk, and secondly, a lot of women who were treated despite having non-diagnostic abnormalities on their screening” by dual-energy x-ray absorptiometry (DXA), coauthor Dr. Joshua Fenton of the University of California, Davis, Medical Center in Sacramento told Reuters Health in a telephone interview.
The U.S. Preventive Services Task Force recommends DXA screening for women 65 and older, as well as younger women at high risk for fractures, Dr. Fenton and his colleagues note in their report, published online Jan. 4 in JAMA Internal Medicine.
Treatment should be based on whether a woman has clinically important DXA abnormalities, they add, as well as her personal fracture risk. However, they add, at their own center DXA reports include anatomic sites, such as lateral lumbar spine, that are not recommended for osteoporosis diagnosis.
To investigate how often osteoporosis overtreatment occurred at their regional healthcare system, the investigators reviewed electronic health and radiology records for 6,150 women age 40–85, who received initial DXA screening in 2006–2011. Screening found 53.1% had normal BMD or isolated osteopenia; 32.8% had non-main-site osteoporosis; and 14.2% had main-site osteoporosis.
Overall, 20.4% of the women screened had one or more osteoporosis risk factors, while 31.1% of the study participants received a new prescription for osteoporosis drug treatment.
About three-quarters of the women with main-site osteoporosis received drug therapy, while just under half of those with non-main-site osteoporosis were prescribed medication. Half of new prescriptions were written for patients without main-site osteoporosis.
Sixty percent of the DXA tests were performed in women younger than 65 with no osteoporosis risk factors, while half of the women who received drug treatment for osteoporosis were younger than 65 and had no risk factors.
Cases of non-main-site osteoporosis were disproportionately due to lateral lumbar spine osteoporosis, Dr. Fenton and his team note. The International Society for Clinical Densitometry does not recommend using lateral lumbar spine readings to diagnose osteoporosis, they add. These findings suggest that doctors may not be aware of these guidelines, or that they believe that osteoporosis identified at any site should be treated, according to the researchers.
