Download Osteoporosis Management - A Wake-Up Call

Nearly 44 million
American men
and women suffer
from osteoporosis,
with osteoporotic
fractures costing the
U.S. $17 billion a
year to treat.
Osteoporosis Management
A WAKE-UP CALL
Osteoporosis, or low bone mass, is a major health threat for people aged 50 and older.
Osteoporotic fractures, especially hip fractures, are major causes of morbidity and
mortality among the elderly population, and half of hip fracture patients never return to
their former state of ambulation. Further, between 12% to 20% of hip fracture patients die
within a year of the fracture.
Osteoporosis is a systemic bone disease characterized by low bone mass and
microarchitectural deterioration of bone tissue, resulting in an increase in bone fragility
and fractures. Although the only symptoms of osteoporosis are the fractures that appear
with the advanced stages of the disease, patients and physicians have an interest in managing this silent disease before fractures occur. Early diagnosis and treatment along with
regular monitoring are crucial to patients’ quality of life and life expectancy. Still, despite
the availability of accessible diagnostic methods and treatment options, osteoporosis is
massively under-diagnosed.
“Given the economic and social costs of osteoporotic fractures, strategies to identify
and manage osteoporosis in the primary care setting need to be established and
implemented.”
From: “Identification and Fracture Outcomes of Undiagnosed Low Bone Mineral Density
in Postmenopausal Women: Results From the National Osteoporosis Risk Assessment,”
Ethel S. Siris, MD, et. al., JAMA. 2001;286:2815-2822
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Diagnosis of the Disease
Treatment Options
Any post-menopausal woman, anyone over 65, and any patient with a pre-existing
medical condition or a lifestyle that may lead to osteoporosis should be assessed
for osteoporosis risk.
The physician’s treatment options for osteoporosis
have expanded in recent years. For many years,
hormone replacement therapy (HRT), originally
prescribed for a number of menopause-related
symptoms, was the treatment of choice for
osteoporosis and the prevention of fractures. In
recent years, drugs developed for this purpose,
such as biphosphonates and Selective Estrogen
Receptor Modulators (SERMs), have been
introduced and many more are being
researched. Users of these medications
demonstrate a decrease in fracture rate.
The diagnosis of the disease by the physician should be based on the patient’s
medical history, osteoporosis risk assessment results, and the results of bone
densitometry or bone sonometry tests.
The patient’s medical history should be taken, with an emphasis on the risk factors
for osteoporosis. Risk factors for osteoporosis include:
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A previous atraumatic fracture
Family history of osteoporosis
Body weight of 127 lbs. or less
Early menopause (before age 45)
Diet low in calcium and Vitamin D
Inactive lifestyle
Smoking
Use of medications affecting bone (thyroid medications, Dilantin, cortisone/
prednisone, chemotherapy, or Heparin)
A wide range of devices are used to assess fracture risk. These tests measure bone
either at central (axial) skeletal sites such as the spine or hip, or at peripheral
skeletal sites such as the forearm or heel. Technologies used to measure bone
include radiation-based technologies and ultrasound-based technologies.
Radiation-based Technologies
Dual X-ray Absorptiometry (DXA) exams that measure bone mineral density (BMD)
have been used to assess fracture risk since 1987. The devices are generally used
to evaluate bone at the lumbar spine or the proximal femur, and cost $45,000 to
$100,000. Other radiation-based technologies for diagnosis include quantitative
computed tomography (QCT) and radiographs, but these are less common than
DXA.
Because of their cost, bulk, and the licensing requirement for operating X-ray
based devices, these technologies are typically available at larger clinics and
specialty providers.
Radiation-based peripheral measurement methods are also available. These devices
include peripheral DXA (pDXA), radiographic absorptiometry (RA), and
peripheral quantitative computed tomography (pQCT) devices, and are typically
priced between $10,000 to $25,000. These devices require radiology licensing for
operation.
The Physician’s Responsibility
Aware of the serious consequences of
osteoporosis, physicians should work to
diagnose and treat osteoporosis before a
fracture occurs. Physicians also may wish to
educate patients about the disease and about
what can be done to reduce fracture risk—even
if the patient has already had a fracture.
A recently published study found that nearly half
of post-menopausal women in the United States
have undiagnosed osteoporosis. In order to
stem this epidemic, the researchers concluded
that management of osteoporosis —from early
diagnosis, to treatment, to regular
monitoring—be moved to the primary care
setting. With the personalized relationship of
the primary care physician to the patient, along
with new advanced and compact solutions for
osteoporosis diagnosis, patients and their
physicians can win the war against osteoporosis.
Quantitative Ultrasound
Quantitative ultrasound (QUS) devices evaluate bone by measuring different
properties of an ultrasound wave emitted through or along bone. These systems
differ from imaging ultrasound systems in that they analyze quantitative,
measurable aspects of the ultrasound wave, such as how fast it travels, rather than
an image produced by ultrasound.
QUS devices may measure the bone at one skeletal site or at multiple skeletal sites
for added measurement flexibility and fracture discrimination. Measurement
results from QUS devices are affected by a number of bone characteristics,
including bone mineral density, elasticity, cortical thickness, and the microarchitecture of the bone, all of which affect bone strength.
QUS devices are radiation-free, compact, easy to operate, and do not require
licensing for use. QUS devices are typically priced between $10,000 and $25,000.
Sponsored by Sunlight Medical, manufacturer of
Sunlight Omnisense ®, the only multi-site bone
sonometer available worldwide.
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Copyright 2002: Health Industry Distributors Association