A Perfect Storm for Broken Bones

“About 80 percent of patients having a hip fracture are never treated” for osteoporosis, Dr. E. Michael Lewiecki, director of the fresh Mexico Clinical Research & Osteoporosis Center in Albuquerque along with lead author of the study, said in an interview, “although almost all have osteoporosis along with are at risk of another hip fracture.”

Although bone-sparing medication has been shown to reduce the risk of a second hip fracture, one study of 22,598 patients found of which use of the drugs declined coming from “an already dismal 15 percent in 2004 to an abysmal 3 percent inside last quarter of 2013,” Dr. Sundeep Khosla, a bone specialist at the Mayo Clinic in Rochester, Minn., wrote in an editorial in 2016 inside Journal of Bone along with Mineral Research. He likened the situation to not treating patients for high blood pressure or elevated cholesterol following a heart attack.

Calling This specific “a crisis inside treatment of osteoporosis,” Dr. Khosla said, “Despite the development of several effective drugs to prevent fractures, many patients, even those who unequivocally need treatment, are either not being prescribed osteoporosis medication at all, or when prescribed, refuse to take them.”

The problem is actually hardly trivial, both for patients along with society at large. Considering hip fractures alone, depending on how they are treated, average direct medical costs for the first six months range coming from $34,509 to $54,054, most of which is actually paid for by Medicare, the study authors wrote. Each year more than 300,000 people over 65, three-quarters of them women, are hospitalized having a fractured hip.

The personal costs are far greater. About 20 percent to 30 percent of patients die within a year following a hip fracture along with, the researchers reported, “Of those who survive, many do not regain their pre-fracture level of function. About 50 percent of patients with hip fractures will never be able to ambulate without assistance along with 25 percent will require long-term care.”

several factors may have contributed to the downward trend in hip fractures of which ended in 2012, according to Dr. Ethel Siris, a co-author of the fresh study along with director of the Toni Stabile Osteoporosis Center of the Columbia University Medical Center in fresh York.

“The population may be getting healthier, people are doing more exercise along with may be more careful about falling,” she suggested in an interview. although most likely a leading factor, she along with her co-authors believe, was the introduction in 1995 of the drug Fosamax, a bisphosphonate of which slows or prevents the loss of bone density, resulting in stronger bones.

Fosamax is actually currently available generically as alendronate, along with has been joined by several some other medications capable of promoting stronger bones. However, Dr. Siris said, “There is actually clearly a treatment gap. Prescriptions have fallen off, along with even when people at risk are offered medication, they are refusing to take This specific.”

Millions of prospective patients who could benefit coming from bone-preserving drugs are currently afraid to take them. The fear probably has its roots in overly aggressive marketing along with doctors who overprescribed bisphosphonates for every patient inside beginning stages of bone loss, a condition called osteopenia, with treatment often continued years longer than currently considered appropriate.

Then inside early 2000s, alarming news reports began to appear linking extended use of bisphosphonates to two uncommon bone problems: a very rare fracture of the femur along with an even rarer condition called osteonecrosis of the jaw. A fear of these complications resulted in more than a 50 percent decline in bisphosphonate use coming from 2008 to 2012, Dr. Khosla said.

At the same time, Medicare reimbursements for bone density tests were sharply reduced, along with doctors who did them in private offices could no longer afford to, which limited patient access along with diagnosis along with treatment of serious bone loss despite major improvements in treatment guidelines, Dr. Lewiecki said.

inside more than two decades since bisphosphonates were introduced, “we’ve learned a lot about how to treat along with whom to treat,” he said. “We’re much wiser currently about selecting patients for treatment.” No longer is actually osteopenia a condition of which by itself warrants medication unless some other factors indicate the patient includes a significantly increased risk of breaking a major bone.

Patients should be treated if their bone density measurement indicates osteoporosis inside hip, spine or forearm, the experts said. although even if the test indicates only osteopenia, Dr. Siris said, “patients should be considered osteoporotic if they already sustained a nontraumatic fracture inside hip, spine, shoulder, pelvis along with sometimes the wrist or if they score high enough on FRAX,” an online fracture risk calculator to estimate one’s risk of breaking a hip or some other major bone inside next 10 years. Her advice is actually three-pronged: “medication when appropriate, an adequate intake of calcium along with vitamin D, along with don’t fall.” “Treatment should be individualized,” Dr. Khosla said. “Each patient is actually different, with different family history, risk factors, how fast they’re losing bone along with their personal concerns. If the focus is actually on patients having a high risk of fracture, the evidence is actually clear of which the benefits of drug treatment well outweigh the risks.”

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