Older Women at Highest Risk for Hip Fractures, Least Likely to Get Screening

A new study by Medical College of Wisconsin researchers has found that women who most need bone density testing to determine if they have osteoporosis are the least likely to get it. They are older women who are among the highest risk groups and who suffer most if they break a bone. The study is published in the March issue of the Journal of the American Geriatric Society.

“Over half of hip fracture patients never regain their prior level of functioning and 20 percent of them require nursing home care,” according to Joan M. Neuner, M.D., M.P.H., lead author and assistant professor of medicine at the Medical College. Dr. Neuner is on the staff at Froedtert Hospital. “Women are very interested in preventing bone fractures. In an earlier study, 80 percent of women said they would “rather die” than enter a nursing home with a hip fracture.”

Osteoporosis, in which the body breaks down bone faster than it is replaced, leading to lace-like, fragile bones, is a significant risk for older women. Nineteen percent of women in the age 65-74 group have it, 32.5 percent of women age 75-84, and over half of women over age 85.

The research team did a statistical analysis to see if older women are more or less likely to have the bone density test that would tell them their bone status. The retrospective study - one in which they looked at existing data to gain a new understanding - looked at the Medicare records of nearly 44,000 women from age 65 to 90 to see how many of them had a bone density test from 1999 (the first year Medicare paid for it) to 2001. They looked at the association between frequency of testing and the age of the women, controlling for factors such as socioeconomic class, race and other diseases they may have had.

“Since osteoporosis can be helped with appropriate therapy, it is especially important for older women to find out whether or not they need the therapy. Treatment with hormones or bone-building drugs can slow the process, rebuild some bone and reduce the risk of fracture by one-third,” Dr. Neuner says.
The best scenario would be the oldest women being the most frequent subjects of bone density screenings. That did not prove to be the case. In fact, the research team found just the opposite. The older the age group, the fewer women had bone density tests.

The numbers were not heartening: 27 percent of women in the youngest age group, 65-70, had the test. At age 71-75, only 25.6 percent had it and; after age 75, the number fell to less than 10 percent.

Since this was a statistical study and no women were interviewed, the researchers could not determine the reason why older women failed to get the test. But they offer some possible reasons:

Physicians not realizing the importance of bone density testing, or not being aware of how great women’s life expectancy is - at age 80 most women can expect to live another nine years
Physicians not being aware that osteoporosis treatment can reduce the risk of fracture in just three years
Women having side effects from the treatment drugs or just not liking to take prescription medications.
Women not realizing that they are at risk, or mistakenly believing that osteoporosis is natural part of aging

The study points out the need for greater patient and physician education to convince women to get the testing they need, especially as they grow older and to determine if osteoporosis therapy would benefit them.

“Preventive care for older patients must be performed with an understanding of their life expectancy and values,” Dr. Neuner says. “Osteoporosis screening may offer important opportunities to improve quality of life for many older patients.”

The study was funded with a grant from National Institutes of Health. Other members of the research team were Neil Binkley, M.D., associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, Madison; Rodney A. Sparapani, M.S., Health Policy Institute biostatistician; Purushottam W. Laud, Ph.D., professor of the division of biostatistics at the Health Policy Institute; and Ann B. Nattinger, M.D., M.P.H., professor and chief of medicine and Lady Riders Professor of Breast Cancer Research.

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