Osteoporosis Treatments Feared and Underused

Despite an apparent and increasing need for osteoporosis treatments, fewer people today are taking the medications both here in the United States and abroad.

Why? Apparently, it’s due to a combination of physicians denying treatment to low-risk patients and patients are refusing treatment due to fear of side effects, according to Christian Roux, M.D., and Karine Briot, M.D., writing in a recent issue of Lancet Rheumatology.

The trend applies to both new and existing patients who have completed at least one treatment course. This is concerning because fragility fractures are associated with increased morbidity and mortality and are more common in elderly populations, which is growing.

“The number of elderly patients at high risk of falls and fractures is expected to increase dramatically in the next few decades, and in some countries the number of centenarians has climbed sharply,” the authors wrote.

The authors provided the following evidence: In the United States from 2001-2009, only 19 percent of patients with fragility fractures received pharmacotherapy.
In 2002, 40 percent of patients treated for a hip fracture received medication for osteoporosis within 12 months of being discharged from the hospital, which compares to 20 percent in 2011. Plus, the number of hip fractures that typically occur in the U.S. annually declined between 2002 and 2012, but they plateaued between 2013-2015 and could be due to a decline in osteoporosis care.

A study of 10 European countries found that only 35 percent of women who experienced at least one fracture over one year, were prescribed pharmacological treatment.

In the U.S., not all insurance companies will cover the cost of a dual-energy x-ray absorptiometry (DXA) which measures bone density, particularly for asymptomatic patients under 65 years old.

Related:  The Side Effects of Osteoporosis Treatments

“Among the reasons for this crisis in the treatment of osteoporosis are insufficient awareness of osteoporosis among health-care providers and the fear of side-effects of some of the treatments-ie, osteonecrosis of the jaw, atypical femoral fractures, atrial fibrillation, and hypocalcaemia,” the authors wrote.

In reality, they said, the number needed to harm is much higher than the number needed to treat. “Many more patients benefit from such treatment than experience serious harm. Nonetheless, patients and practitioners are wary of these side-effects, possibly as a consequence of negative publicity in the media,” they wrote.

Apparently, patients are looking for possible treatments. The authors described huge spikes in Google searches for “Fosamax” (alendronate) from 2004 to 2015.

The searches grew in 2006, 2008, and 2010 after media reports of side effects associated with Fosamax.

An issue, they said, may be due to a lack of understanding among some physicians of osteoporosis as a disease. “Osteoporosis might not be perceived as a disease, but rather as natural, inevitable, bone deterioration. Accurate communication about fracture risk and bone fragility must be improved to optimize health care for this population,” the authors wrote.

REFERENCEProf Christian Roux, M.D., and Karine Briot, M.D. “The crisis of inadequate treatment in osteoporosis,”Lancet Rheumatology. Feb. 1, 2020. Published February, 2020. DOI:https://doi.org/10.1016/S2665-9913(19)30136-5