Osteoporosis Treatment Crisis – 2018 Update
Marc Hochberg, MD, MPH, MACP, President, USBJIMy friend and our Past-President, Dr. David Pisetsky, wrote his President’s Message on the topic of the “Osteoporosis Treatment Crisis” in October 2016. He noted that “osteoporosis care is lagging despite impressive advances in drug therapy and the recognition of the importance of diet and exercise” and raised concerns about the roles of different members of the health care team in the diagnosis and management of the patient with osteoporosis. Since the publication of his message, there have been a number of important publications about the increasing burden of osteoporosis and related fractures among the adult population in the United States; I would like to take this opportunity to review some of these data for you.
Dr. Anne Looker, formerly of the National Center for Health Statistics and the Centers for Disease Control and Prevention and one of the authors of the chapter on Osteoporosis in the Burden of Musculoskeletal Diseases (BMUS), analyzed data from the National Health and Nutrition Examination Survey (NHANES) and reported that the prevalence of osteoporosis and low bone mass increased among U.S. adults aged 50 years and above in 2013-14, the most recent two-year period with available data. Indeed, over 10 percent of adults in this age group had osteoporosis either at their hip or in their lumbar spine. The increase could not be explained by changes in body weight, smoking, dietary milk intake. In another publication, she reported that over 5 percent of U.S. adults aged 40 and above had spine fractures with the burden increasing with increasing age exceeding 10 percent in persons aged 70-79 and approaching 20 percent in persons aged 80 and above. Finally, Dr. Michael Lewiecki, a member of our advisory committee for “Fit to a T”, the USBJI Public Education program for bone health and fracture prevention, reported that the rate of hip fractures among U.S. women aged 65 and above had plateaued in the years 2013-15 ending an almost two-decade long decline resulting in over 10,000 more hip fractures than expected. It is well recognized that the occurrence of a hip fracture is associated with excess mortality, increased likelihood for nursing home admission and persistent disability among survivors in the year following the fracture.
In an attempt to address these issues, the American Society for Bone and Mineral Research, one of the USBJI founding member organizations, organized a Fracture Prevention Stakeholder Summit in July 2017 that has led to a new “Strategic Roadmap to Prevent Secondary Fractures.” The USBJI was involved in the development of the “Roadmap” and strongly endorses its recommendations. The Fit to a T Advisory Committee is revising the core material in “Fit to a T” to reflect the key messages of the “Roadmap” with greater emphasis on adults aged 65 and above with a prior fracture and informing them about treatment options including both diet, exercise, fall prevention strategies and use of FDA-approved medications that have been shown to be effective in reducing fracture risk. We anticipate publishing the updated chapter on Osteoporosis in the upcoming 4th edition of BMUS during 2018. Finally, we look forward to continuing this dialogue with our members and other interested parties and welcome your comments via our website.