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Rising fracture rates hint at ‘crisis’ in osteoporosis care
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Despite a drop in fracture rates among U.S. adults aged at least 50 years between 2007 and 2013, fracture rates generally increased between 2013 and 2017, possibly because of a decline in DXA screening, according to findings presented at the ASBMR 2018 annual meeting.
“The osteoporosis treatment gap has gotten so severe that it’s been called a crisis in the care of osteoporosis,” E. Michael Lewiecki, MD, director of the New Mexico Clinical Research and Osteoporosis Center and director of Bone Health TeleECHO Clinic at the University of New Mexico Health Sciences Center in Albuquerque, told Endocrine Today. “Most people who have had fractures, for example, are not being treated to reduce the risk of the next fracture. Most people that need a bone density test to evaluate fracture risk are not getting it, and even when people are started on treatment, many of them don’t take treatment long enough to benefit from a reduction in fracture risk.”
Lewiecki and colleagues assessed data from adults aged at least 50 years who were enrolled in Medicare Advantage or commercial health plans and experienced a fracture between 2007 and 2017 (n = 513,953). Between 2007 and 2013, fracture rates, both for men and women aged 65 years or older, generally declined; the researchers observed a decrease in fracture rate of 14.67 per 1,000 person-years in 2007 to a rate of 11.79 in 2013.
Women aged at least 65 years had the highest fracture rates throughout the 6-year span, but there was a decline from 27.49 per 1,000 person-years in 2007 to 22.08 per 1,000 person-years in 2013. However, that rate rose to 24.92 per 1,000 person-years in 2017. There was also a decrease in the fracture rate of men aged at least 65 years from 2007 (12 per 1,000 person-years) to 2013 (10.72 per 1,000 person-years), but an increase to 12.04 per 1,000 person-years by 2017. For men and women aged 50 to 64 years, fracture rates remained relatively steady throughout the study period, but researchers noted a roughly 5% increase in the likelihood of a second fracture for all individuals during each year following an initial fracture.
“I think we just did a better job of following the guidelines that we now have. For instance, there’s general agreement in the U.S. that all women aged 65 and older should have a bone density test to evaluate fracture risk,” Lewiecki said. “There’s also general agreement that patients who have had a major osteoporotic fracture, such as a fracture of the spine or a fracture of the hip, should be treated to reduce the risk of the next fracture. We’re not even coming close to following those guidelines that we now have.”
Researchers also found changes in fracture rates between 2013 and 2017 based on location. There were more instances of fracture in the spine, femur and tibia/fibula during the study period, while fractures to the ankle or pelvis both declined. Fractures rates at most other locations included in the study (radius/ulna, hip, shoulder and carpal/wrist) remained relatively the same.
“The fracture trends did vary according to different patient demographics, but it’s cause for great concern for anybody who cares about the consequences of fractures in the U.S. and worldwide,” Lewiecki said. “This is an alarm going off that tells us we’re going in the wrong direction. We ought to be evaluating more patients, treating more patients and doing a better job of reducing fracture risk.” – by Phil Neuffer
Reference:
Lewiecki EM, et al. Abstract FRI-742, SAT 742. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 28-Oct. 1, 2018; Montreal.
Disclosure: Lewiecki reports he receives research grants and serves on the scientific advisory boards for Amgen and Radius.