History of broken bones overlooked when treating osteoporosis

Women who need treatment for osteoporosis–thinning of the bones–may not be receiving it because their history of fractures is not being considered by physicians, according to a study done in part at the University of Alberta.

Previous fractures indicate that bones are weaker than normal, but the information isn’t being taken into account when treating for osteoporosis, said Dr. Kerry Siminoski, professor of radiology and diagnostic imaging at the University of Alberta.

The joint study of 1,323 women who were receiving their first ever bone density tests, revealed a 40 per cent gap between those who should have received treatment according to guidelines and the number actually treated. The difference was that those with only borderline bone density problems who had also had past fractures, were not being treated. “To get people who are at the highest risk of osteoporosis, we have to take into account fracture history,” Dr. Siminoski said. “We found that it was not being used at all.”

Women with previous fractures of the ankle, hip, backbone (which often goes undetected) and especially the wrist after age 20 are two to 10 times more likely to be at future risk of osteoporosis. Results of the study, which also involved McMaster University and the Centre for Evaluation of Medicines, appear in the February issue of Osteoporosis International.

Bone density tests show how much calcium is in the bones, but fracture history is also valuable in giving a more complete picture, Dr. Siminoski said. “In a way, these people have tested their own bones and shown they have a tendency to break.”

Bone densitometry has been widely available for the last ten years, so bone density has tended to be the dominant factor used by physicians in diagnosing and treating the condition, Dr. Siminoski said. “Only now are other factors like fracture history being considered.”