Advances and obstacles apparent in osteoporosis care

ORLANDO Fla. — Current tools and recommendations available to physicians are allowing them to identify and treat patients with osteoporosis more successfully than ever before.

With the recent FDA approval of once-yearly bisphosphonates such as Reclast (zoledronic acid, Novartis), treating osteoporosis has become easier for both physicians and patients, according to a report at the American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress, here. The medication, which was approved last year and is administered intravenously, provides patients with year-long bone protection.

"Bisphosphonates have become the agents of choice for first-line treatment of osteoporosis," said Nelson B. Watts, MD, FACP, MACE, director of the University of Cincinnati Bone Health and Osteoporosis Center.

The National Osteoporosis Foundation recently released guidelines for the diagnosis and treatment of osteoporosis to provide physicians with decision-making tools to use in their clinical practice. In addition to providing guidelines for pharmacological therapy, Watts highlighted important features of the guidelines:

They offer insight into the diagnosis and treatment of osteoporosis in men over the age of 50 years;
They can include black, Asian, Hispanic and other postmenopausal women when identifying risk factors of osteoporosis; and
They can apply the World Health Organization's Fracture Risk Assessment Tool to estimate the 10-year absolute fracture risk due to low bone mass or osteoporosis.

Despite the advances in both the diagnosis and treatment of osteoporosis, fiscal and health care issues create barriers for both physicians and patients, he said. Watts highlighted these hurdles, which include Medicare cuts that will decrease patients' access to dual-energy X-ray absorptiometry (DXA).

Reimbursement rates much lower than the cost of performing the procedures threaten to cause health care providers to eliminate the use of DXA in their facilities.

"If the cuts go on as planned, there will be no more DXAs in clinical centers. If that bothers you, get involved," he said.

Watts recommended contacting organizations like the National Osteoporosis Foundation and the International Society for Clinical Densitometry, as well as local representatives and senators to ask them to support a bill to roll back DXA reimbursement rates to the 2006 rates.

"There are clearly important public health issues involved in osteoporosis," Watts said. "The decrease in DXA reimbursement is a serious threat to accessibility to our patients and would even worsen the current problem of underdiagnosis."

For more information:
Watts NB. Osteoporosis: What's new and what's next. Presented at the American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress. May 14-18, 2008. Orlando, Fla.