|Melton, L Joseph|
Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/15/2009
Publication Date: 1/20/2010
Citation: Dawson-Hughes, B., Looker, A.C., Tosteson, A.N., Johansson, H., Kanis, J.A., Melton, L. 2010. The potential impact of new National Osteoporosis Foundation guidance on treatment patterns. Osteoporosis International ; 21:41-52. Interpretive Summary: A revised National Osteoporosis Foundation Clinician’s Guide for the Prevention and Treatment of Osteoporosis, published in 2008, makes recommendations about who should be considered for pharmacotherapy to lower the risk of future fractures based on a health economic analysis. The Guide utilizes the World Health Organization formula, referred to as FRAX (trademark). This formula employs clinical risk factors along with bone mineral density (BMD) of the hip to estimate 10-yr fracture probability. This study was done to determine how many men and women in the U.S. might be eligible for treatment by the NOF Guide. The analysis was done in the National Health and Nutrition Examination Survey III data set and involves 6117 randomly selected men and women age 50 and older. The proportions of women and men, respectively, eligible for treatment by the new NOF Guide are: 45% and 24% among non-Hispanic whites, 26% and 13% among Mexican Americans, and 12% and 8% among non-Hispanic blacks. We conclude a substantial proportion of older Americans warrant consideration for pharmacotherapy to lower their fracture risk.
Technical Abstract: Little information is available on prevalence of osteoporosis risk factors or proportions of U.S. men and women who are potential candidates for treatment. The prevalence of risk factors used in the new National Osteoporosis Foundation (NOF) FRAX (trademark) based Guide to the Prevention and Treatment of Osteoporosis was estimated using data from the third National Health and Nutrition Examination Survey (NHANES). Risk factors not measured in NHANES III were simulated using World Health Organization cohorts. The proportion of U.S. men and postmenopausal women age 50+ years who are treatment candidates by the new NOF Guide were calculated; for non-Hispanic white (NHW) women, the proportions eligible by the new NOF Guide was compared with that based on an earlier NOF guide. Twenty-two percent of men and 41% of women were potential candidates for treatment to prevent fractures by the new NOF Guide. Among NHW women, 53% were potential candidates by the previous NOF Guide compared with 45% by the new Guide. Almost one quarter of men and 41% of postmenopausal women are eligible for osteoporosis treatment consideration by the new NOF Guide. However, fewer NHW women are eligible by the new Guide than by the previous NOF Guide.