Correlates of use of antifracture therapy in older women with low bone mineral density

Abstract

Background: Guidelines exist for treatment of low bone mineral density (BMD). Little is known about patient characteristics associated with use of treatment.

Objectives: To determine patient-related correlates of medication use following screening dual x-ray absorptiometry (DXA) of older adults.

Design: Secondary analysis of a prospective cohort study.

Setting: Pittsburgh, PA and Memphis, TN.

Participants: Community-dwelling women between the ages 70 and 79 years enrolled in the Health, Aging, and Body Composition (Health ABC) Study.

Measurements: Risk factors for fracture and BMD of the hip were assessed at baseline. Patients and their community physicians were supplied the results of the DXA scan. Prescription and over-the-counter medication use was collected at annual exams for 2 years.

Results: Of 1,584 women enrolled in Health ABC, 378 had an indication for antifracture therapy and were not receiving such treatment at baseline. By the second annual follow-up examination, prescription antiresorptive medication was reported in 49 (13.0%), whereas 65 (17.2%) received calcium and/or vitamin D supplementation. In adjusted models, the strongest predictor for use of any antifracture medicine was presence of osteoporosis [vs osteopenia, odds ratio (OR), 2.9 (1.7 to 4.7)], white race [OR, 2.6 (1.5 to 4.8)], and receipt of the flu shot [OR, 2.2 (1.3 to 3.8)]. Neither a history of falls nor prior fracture was associated with use of antifracture medications.

Conclusion: Even when physicians of study participants were provided with DXA scan results, 70% of older high-functioning women with an indication for therapy did not start or remain on an antifracture therapy. Substantial room for improvement exists in fracture prevention following a diagnosis of low BMD-especially among women with a history of falls, prior fractures, and among black women.

FIGURE 1

Women included in the current secondary analysis of the Health, Aging and Body Composition cohort. Of 378 women with an National Osteoporosis Foundation indication for antifracture therapy and not on therapy at baseline, only 30% initiated some form of treatment by 2 years. AFT, antifracture therapy; DXA, dual x-ray absorptiometry.