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Doctors Still Miss Osteoporosis Signs

Many older women go undiagnosed, study finds

WEDNESDAY, Feb. 6, 2002 (HealthDayNews) -- Thanks to ad campaigns and media coverage, many older women know they're at risk for osteoporosis.

However, a new study suggests doctors are still leaving their patients in the dark about this bone-weakening condition.

Culling through data from a national health survey, researchers discovered physicians diagnosed the presence of osteoporosis in only 2 percent of female seniors. That percentage falls far below the estimated national rate of 20 percent to 30 percent.

Even when the condition was discovered, treatment was lacking, the study found. Of those who had osteoporosis or related problems, only 36 percent received the appropriate drug treatment.

Doctors often don't worry about osteoporosis because they are too busy looking at other medical problems, explains study co-author Dr. Stephen H. Gehlbach, dean of the School of Public Health at the University of Massachusetts.

However, doctors must learn to look for signs of osteoporosis, just as they check blood pressure and cholesterol levels, because all three are silent conditions, he adds.

"People are less aware that osteoporosis is a similar kind of situation," Gehlbach explains.

Osteoporosis refers to a reduction in the density of bones that makes them more likely to fracture under stress. "It's about thinner and more brittle bones," Gehlbach says. "The whole network is weaker."

The condition often ravages older women: "All the little old ladies that go around stooped over," he says. "A lot of those women have vertebral fractures, spinal fractures that have accumulated over the years."

About 20 percent to 25 percent of women with osteoporosis will suffer spinal fractures without knowing it, he adds.

Gehlbach and his colleagues analyzed data from the National Ambulatory Medical Care Survey between 1993 and 1997. They looked at how many white women who were 60 and older were diagnosed with osteoporosis by their primary-care physicians. The study findings appear in the February issue of the American Journal of Public Health.

The researchers found doctors diagnosed osteoporosis or spinal fractures in fewer than 2 percent of women, although the national rates are estimated to be 20 percent to 30 percent.

The number spread matters, Gehlbach says. While osteoporosis sometimes causes no noticeable problems, it can lead to disability and deformities. Hip fractures are especially common.

"Often the fracture of the hip, and the subsequent hospitalization, is really the beginning of a downward spiral," Gehlbach says. "It frequently signals the end of independent living. An unhappy chain of events often follows."

Until about 10 years ago, Gehlbach explains, doctors considered weak bones and fractures to be a simple fact of aging. Now, experts emphasize prevention through proper consumption of calcium in younger years.

Doctors are only now realizing osteoporosis is treatable once it begins, says Dr. Bruce Ettinger, an endocrinologist and senior investigator with the Kaiser Permanente Medical Care Program.

"The traditional training about osteoporosis has been that it is a disease that can be prevented, but not treated," says Ettinger, who studies women's health. "Now we have a number of excellent drugs and other interventions that reduce fracture risk really well, and we have better ones coming in the future."

The pharmaceutical industry, which funded Gehlbach's study, has done a good job of making people afraid of osteoporosis, Ettinger adds.

However, he says, more resources should be devoted to treatment instead of prevention.

"We're wasting a lot of time and energy and money on drugs for people who don't need it, drugs for women in their 40s who have slightly low bone density," he adds.

What To Do

Learn the basics about osteoporosis, including information about how it strikes some men, from the National Osteoporosis Foundation.

Learn about the dangers of undiagnosed osteoporosis from the National Institutes of Health.

SOURCES: Interviews with Stephen H. Gehlbach, M.D., MPH, dean, School of Public Health, University of Massachusetts, Amherst; Bruce Ettinger, M.D., endocrinologist and senior investigator, division of research, Kaiser Permanente Medical Care Program, Oakland, Calif.; February 2002 American Journal of Public Health
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