Are Women Overtreated for Osteoporosis?

Less is more for women receiving osteoporosis drug therapy, as new research suggests that this patient population may be overtreated.

Researchers from the University of California, Davis Medical Center noted that the US Preventative Services Task Force recommends dual energy X-ray absorptiometry (DXA) screening for women aged 65 years or older, as well as younger women with an elevated fracture risk.

However, in order for these targeted women to benefit from screenings, physicians have to begin drug therapy based on the presence of DXA abnormalities and patient risk.

The researchers set out to estimate the frequency of osteoporosis overtreatment in a regional health center by examining 6150 women’s electronic health records. All of the women were aged 40 to 85 years and received DXA testing.

The researchers compared the percentages of women in each DXA category—which included all sites normal, non-main-site osteopenia, main-site osteopenia, non-main-site osteoporosis, and main-site osteoporosis—with those who received new prescriptions, and also noted the new prescriptions in each DXA category.

Over the 6-year observation period, the researchers learned that 1912 women (about 31%) received new osteoporosis drug treatment, but only 1 in 5 of the total population studied had 1 or more osteoporosis risk factors.

Around three-quarters of the 2016 women with main-site osteoporosis received new drug therapy, as well as almost half of those with non-main-site osteoporosis. Another 16% with isolated osteopenia but no osteoporosis received a prescription.

In other words, patients started to receive prescriptions for drugs even though their readings from various anatomic sites are not typically used for diagnosing osteoporosis.

Study author John A. Robbins, MD, MSH told Pharmacy Times that this is one area physicians need to work on.

“Drug companies influence women to be worried about osteoporosis, which is reasonable, but…I think it is a bit like the overuse of antibiotics,” Dr. Robbins said. “MDs feel like they need to do something, and it is easier to order a test and a medication than delve into questions in-depth. Everyone is pressed for time. I always look at a patient’s DXA myself, but busy, practicing MDs don’t have time.”

He added that it might be hard for pharmacists to argue against a physician’s order for an osteoporosis medication.

The study findings were published in JAMA Internal Medicine.