Identifying and treating people at high risk for fracture from postmenopausal osteoporosis

Details

Activity Description / Statement of Need:

In this online CME self-learning activity:

Osteoporosis is a disease common among elderly patients and is increasing in frequency as senior citizens begin to represent a larger share of the US population. In the US, fragility fractures are associated with 1.7 million hospitalizations, and the number of annual of osteoporotic fractures is expected to rise to three million annually in the next few years, with annual treatment costs expected to be $25.3 billion. Despite the morbidity and mortality associated with osteoporosis, practice gaps related to suboptimal screening, risk assessment, and management practices have led to underdiagnosis and undertreatment of this condition.

Osteoporosis screening may identify people at increased risk of low-trauma fracture who may benefit from interventions to minimize risk. The USPSTF recommends screening for osteoporosis with BMD testing in all women 65 years or older and in postmenopausal women younger than 65 years but at increased risk of osteoporosis. Risk for osteoporosis should be determined by a formal clinical measurement tool, such as FRAX™, which assesses 10-year fracture risk. Diagnosis of osteoporosis can be made based on the history of fragility fracture or with a T score of 2.5 SD or more below the young adult mean BMD.

However, the literature has consistently illustrated underutilization of screening and diagnostic measures. Clinicians should be aware that prior fragility fracture is sufficient for diagnosis of osteoporosis, and yet only one-quarter of patients with a prior fragility fracture were aware they had this condition. Underdiagnosis therefore represents a compelling safety consideration, as 20% of patients become dependent on long-term care after a hip fracture, and 20% die within a year from related complications. Because these outcomes represent significant quality and safety considerations, a number of national quality measures that are strongly supported by the evidence have been developed to address shortcomings in care. 

Target Audience:

HCPs specializing in endocrinology, internal medicine, geriatrics, and women’s health; physician assistants, nurse practitioners, and pharmacists who practice in those areas of specialty; and those who otherwise commonly care for or clinically encounter patients with postmenopausal osteoporosis.

Learning Objectives

By the end of the session the participant will be able to:

• Determine a given postmenopausal patient’s fracture risk using validated assessment tests.
• Describe the relative efficacy and safety of presently available agents used to treat and prevent postmenopausal osteoporosis.
• Formulate a treatment plan for a patient with postmenopausal osteoporosis at risk of fracture.
• Recall quality measures aimed at osteoporosis treatment and fracture prevention and how to incorporate them into practice.
• List barriers to care in the management of osteoporosis.