E. Michael Lewiecki, MD, on Raising Awareness of Osteoporosis

Osteoporosis is an underrecognized condition associated with significant adverse health outcomes.

Research has shown that among women who experienced a first hip fracture, only 17% of the women had osteoporosis assessment and/or treatment within 6 months of their fracture, and only 23% had osteoporosis assessment/treatment within 12 months of their fracture.¹

A study conducted by E. Michael Lewiecki, MD, and colleagues showed a lack of awareness of the diagnosis of osteoporosis and of osteoporotic fracture risk among postmenopausal women in the United States.²

Rheumatology Consultant caught up with Dr Lewiecki, who is the director of the New Mexico Clinical Research & Osteoporosis Center and a clinical assistant professor of medicine at the University of New Mexico Health Sciences Center, about his research and the importance of raising awareness about osteoporosis and fracture risk.

Rheumatology Consultant: What factors do you think contribute to the underdiagnosis and undertreatment of women at high risk of fracture?

E. Michael Lewiecki: Many factors contribute to the osteoporosis treatment gap, including poor understanding that an existing fracture is a strong predictor of future fractures, misconception that fractures do not have serious consequences, and lack of appreciation that treatment can reduce the risk of fractures. Many patients have a poor understanding of the balance of benefits and risks with treatment and have been led to believe that very rare possible side effects of medications are more common than they really are. We also need to restore access to vital diagnostic services that have drastically declined in recent years because Medicare has reduced reimbursement for office-based bone density tests to levels that are below the cost of providing the test. Many office-based dual-energy x-ray absorptiometry facilities have closed because of this. Legislation to correct this discrepancy has been proposed and should be supported by everyone who recognizes that osteoporosis in an important public health concern.

RHEUM CON: What prompted you to conduct the study?

MW: Identifying and addressing factors that may contribute to the underdiagnosis and undertreatment of women who are at high risk of fracture is crucial. In order to develop strategies to reduce the osteoporosis treatment gap, it is important to understand its origins. In the study, we wanted to learn more about what women thought about osteoporosis and fractures. From the findings, it was surprising that so many women did not understand that a fracture over the age of 50 years was likely due to osteoporosis. What was also surprising was that so many women at risk of osteoporosis had not undergone a bone density test.

RHEUM CON: How can a health care provider educate their at-risk patients about osteoporosis and bone fracture?

MW: The time available for patient encounters is often short and focused on symptomatic problems of immediate concern. It would be helpful if providers and patients recognized that a fracture is a “bone attack” that deserves urgent attention, since the risk of another fracture is highest in the first 1 to 2 years after a fracture. It would also help if more hospitals had a fracture liaison service with a designated nurse coordinator to identify and follow up with patients who have a fracture to ensure the patient received the care they needed. In the office setting, it can be helpful to have a designated person, often a nurse or medical assistant, to serve as an advocate for skeletal health to ensure that patients who need a bone density test and care for osteoporosis actually get it.

RHEUM CON: What are 3 research areas that you think are important for the future management of osteoporosis and bone fracture?

MW: First, I would like to see more studies conducted on how we can use currently available medications most effectively, since new medications are unlikely to become available in the near future. Second, I would like to see more research done on evaluating how we can best communicate to patients the serious consequences of fractures and educate them on the balance between benefits and risks of treatment to reduce fracture risk. Finally, I would like to see development of novel strategies to identify individuals at high risk of fracture before the first fracture occurs.

References:

1. Gillespie CW, Morin PE. Osteoporosis-related health services utilization following first hip fracture among a cohort of privately-insured women in the United States, 2008–2014: an observational study. J Bone Miner Res. 2017;32(5):1052-106 doi:10.1002/jbmr.3079.
2. Lewiecki EM, Leader D, Weiss R, Williams SA. Challenges in osteoporosis awareness and management: results from a survey of US postmenopausal women. J Drug Assess. 2019;8(1):25-31. doi:10.1080/21556660.2019.1579728.

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