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Title: The potential impact of the National Osteoporosis Foundation guidance on treatment eligibility in the U.S.: an update in NHANES 2005-2008

Author
item DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LOOKER, ANNE C. - Centers For Disease Control And Prevention (CDC) - United States
item TOSTESON, ANNA N. - Dartmouth Medical School
item JOHANSSON, HELENA - University Of Sheffield
item KANIS, JOHN A. - University Of Sheffield
item MELTON, L. JOSEPH - Mayo Clinic College Of Medicine

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/1/2011
Publication Date: 6/10/2011
Citation: Dawson-Hughes, B., Looker, A., Tosteson, A., Johansson, H., Kanis, J., Melton, L. 2011. The potential impact of the National Osteoporosis Foundation guidance on treatment eligibility in the U.S.: an update in NHANES 2005-2008. Osteoporosis International. DOI: 10.1007/s00198-011-1694-y.

Interpretive Summary: The 2008 National Osteoporosis Foundation (NOF) Clinician’s Guide indicates who among men and women age 50 years and older should be considered for treatment for osteoporosis. Eligibility is based on a prior spine or hip fracture, a lumbar spine or femoral neck bone mineral density in the osteoporotic range, and the World Health Organization's fracture predictions tool for a hip fracture or any major osteoporotic fracture. The objective of this study was to use National Health and Nutrition Examination Survey 2005-08 data to estimate the proportions of U.S. men and women who are eligible for consideration for treatment according to the 2008 NOF Guide. Among women age 50 and older, treatment eligibility was similar in Mexican American and non-Hispanic white women (32.0% and 32.8%) and higher than it was in non-Hispanic black women (11.0%). Treatment eligibility among men was 21.1% in non-Hispanic whites, 12.6% in Mexican Americans, and 3.0% in non-Hispanic blacks. These results reveal that large proportions of men and women in the U.S. aged 50 years and older are at sufficient risk for fracture to warrant consideration for treatment.

Technical Abstract: This analysis of National Health and Nutrition Examination Survey (NHANES) 2005-2008 data describes the prevalence of risk factors for osteoporosis and the proportions of men and postmenopausal women age 50 years and older who are candidates for treatment to lower fracture risk, according to the new FRAX-based National Osteoporosis Foundation Clinician’s Guide. It is important to update estimates of the proportions of the older U.S. population considered eligible for pharmacologic treatment for osteoporosis for purposes of understanding the health care burden of this disease. This is a cross sectional study of the NHANES 2005-2008 data in 3,609 men and women age 50 years and older. Variables in the analysis included race/ethnicity, age, spinal and femoral neck bone mineral density, risk factor profiles, and FRAX 10-yr fracture probabilities. The prevalence of osteoporosis of the femoral neck ranged from 6% in non-Hispanic black to 12.6% in Mexican American women. Spinal osteoporosis was more prevalent among Mexican American women (24.4%) than among either non-Hispanic blacks (5.3%) or non-Hispanic whites (10.9%). Treatment eligibility was similar in Mexican American and non-Hispanic white women (32.0% and 32.8%) and higher than it was in non-Hispanic black women (11.0%). Treatment eligibility among men was 21.1% in non-Hispanic whites, 12.6% in Mexican Americans, and 3.0% in non-Hispanic blacks. Large proportions of older men and women in the U.S. are at sufficient risk for fracture to warrant consideration for treatment.