Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures.
OBJECTIVE
To determine whether patients with vertebral compression fractures are diagnosed with or treated for osteoporosis.


METHODS
Retrospective cohort study.


METHODS
Two primary care practices in Massachusetts.


METHODS
Two hundred six patients with vertebral compression fractures noted on routine radiographs in 1997-1998.


METHODS
Percentage of patients diagnosed with osteoporosis and treated with prescription medications (estrogen, bisphosphonates, raloxifene, or calcitonin). Factors associated with missed osteoporosis diagnosis and treatment, including risk factors for osteoporosis, comorbidities, vertebral fracture severity, and processes of care communication were also examined.


RESULTS
The median patient age was 76, 71% of the cohort was female, and 13% of patients had a history of corticosteroid use. Thirty-eight percent of subjects (46% of women and 19% of men) were diagnosed with osteoporosis and 32% (39% of women and 14% of men) received prescription medications for osteoporosis. Of women who were diagnosed with osteoporosis, 69% received prescription medications. In adjusted analyses women younger than 50 (adjusted odds ratio (AOR) = 0.09; 95% confidence interval (CI) = 0.01-0.71) and 90 and older (AOR = 0.27; 95% CI = 0.08-0.98) were less likely to be diagnosed with osteoporosis, whereas women with a prior hip or radial fracture (AOR = 3.65; 95% CI = 1.28-10.38) or back pain (AOR = 2.84; 95% CI = 1.38-5.85) were more likely to be diagnosed with osteoporosis.


CONCLUSIONS
Physicians frequently did not diagnose osteoporosis in primary care patients with vertebral fractures, missing an important preventive opportunity for patients at high risk for future fractures. Efforts targeted to improving diagnosis of osteoporosis could improve patient care.
Neuner
Joan M
JM
Center for Patient Care and Outcomes Research and the Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. jneuner@mcw.edu
Zimmer
Jennifer K
JK
Hamel
Mary Beth
MB
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000150:complications*; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class