18- 20 One study found that fewer than 20% of men aged 70 to 75 years received screening with dual-energy X-ray absorptiometry (DXA). 17 Osteoporosis screening and treatment rates are even lower for older men in the US.
15, 16 A recent large study that analyzed insurance claims data of more than 1.5 million US women aged 50 years and older found that fewer than 1 in 4 had osteoporosis screening within the most recent 2-year continuous enrollment period. For example, studies have shown that fewer than 30% of women over the age of 65 years with a known diagnosis of osteoporosis receive treatment, 13, 14 and only 23% of women aged 50 years and older who sustain an osteoporotic fracture receive treatment within the first year after fracture.
2 Despite the high prevalence and health impact of osteoporosis and ample evidence and guidelines supporting osteoporosis screening and treatment for older women and men, 7- 12 screening and treatment rates remain low in the US. 2 The morbidity, mortality, and costs associated with osteoporotic fractures in the US are significant, 1- 6 and the prevalence of osteoporosis and fractures are projected to increase with the aging of the US population in upcoming years. Osteoporosis affects approximately 10 million people in the United States (8 million women and 2 million men), 1 and approximately 50% of postmenopausal women and 20% of white men will sustain an osteoporotic fracture in their lifetimes. © 2018 American Society for Bone and Mineral Research. Despite the limitations of the current body of evidence, our findings indicate there are several strategies that appear worthwhile to enact to try to improve osteoporosis screening and/or treatment rates. The meta-analyses findings were limited by small number of studies in each analysis high between-study heterogeneity sensitivity to removal of individual studies and unclear risk of bias of included studies.
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The only quality improvement strategy for which meta-analysis findings demonstrated significant improvement of osteoporosis care for patient populations including individuals without prior fracture was patient self-scheduling of DXA plus education, for increasing the outcome of BMD testing (risk difference 13%, 95% CI 7%–18%).
For increasing osteoporosis treatment in patients with recent or prior fracture, meta-analyses demonstrated significant efficacy for interventions of fracture liaison service/case management (risk difference 20%, 95% CI 1%–40%) and multifaceted interventions targeting providers and patients (risk difference 12%, 95% CI 6%–17%). For increasing BMD/DXA testing in patients with recent or prior fracture, meta-analyses demonstrated several efficacious strategies, including orthopedic surgeon or fracture clinic initiation of osteoporosis evaluation or management (risk difference 44%, 95% confidence interval 26%–63%), fracture liaison service/case management (risk difference 43%, 95% CI 23%–64%), multifaceted interventions targeting providers and patients (risk difference 24%, 95% CI 15%–32%), and patient education and/or activation (risk difference 16%, 95% CI 6%–26%). Forty-three randomized clinical studies met inclusion criteria. Random-effects meta-analyses were performed for outcomes of BMD/DXA testing and/or osteoporosis treatment. We developed broad literature search strategies for PubMed, Embase, and Cochrane Library databases, and applied inclusion/exclusion criteria to select relevant studies. We performed a systematic review and meta-analysis of the efficacy of quality improvement strategies to improve osteoporosis screening (bone mineral density /dual-energy X-ray absorptiometry testing) and/or treatment (pharmacotherapy) initiation rates. Although osteoporosis affects 10 million people in the United States, screening and treatment rates remain low.
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