By Will Boggs, MD
NEW YORK (Reuters Health) Apr 23 - Fewer than four in ten patients with osteoporotic vertebral compression fractures have been diagnosed with osteoporosis, according to a report in the April Journal of the American Geriatrics Society.

Patients with vertebral compression fractures can benefit from treatment of their osteoporosis, the authors explain, but little is known about the current evaluation and treatment of patients with such fractures.

Dr. Joan Neuner from Medical College of Wisconsin in Milwaukee, Wisconsin and colleagues studied 206 patients with vertebral fractures identified on routine x-rays to determine the rates of diagnosis or treatment for osteoporosis.

Most of the women (68%) and nearly half the men (48%) had multiple compression fractures, the authors report, and many patients had a number of risk fractures for osteoporotic fracture, including chronic oral corticosteroid use and prior fractures.

Only 38% of the overall group, including 46% of the women and 19% of the men, were already diagnosed with osteoporosis, the report indicates.

Less than 40% of women and only 14% of men were receiving prescription medication for the prevention or treatment of osteoporosis, the researchers note, and none of the patients had received chart-documented counseling about exercise or smoking cessation for fracture prevention.

Factors that increased the likelihood of receiving an osteoporosis diagnosis included being a woman with a prior hip or radial fracture and having back pain, the investigators report, and factors decreasing the chance of diagnosis included being a woman under age 50 years and being any patient age 90 or older.

"These results are consistent with prior research findings that few patients with osteoporosis are diagnosed," the researchers comment.

"The findings suggest several potential strategies to improve the care of patients with osteoporosis," they write. "Better communication among clinicians about incidental findings of vertebral fractures could increase the rate of diagnosis of osteoporosis. Further interventions could also be targeted to primary care physicians."

The authors conclude, "Because patients with new vertebral fractures are at high risk for recurrent fractures in the following year, interventions to promote timely clinician response to fractures are likely to greatly benefit patients."

For example, Dr. Neuner told Reuters Health, "if a radiologist finds a compression fracture, that needs to be prominent in an x-ray report so that it does get a busy doctor's attention. Later we may need to have automated alerts for doctors to get BMDs for all women over 65."

J Am Geriatr Soc 2003;51:492-498.

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