A new study in The Journal of Clinical Endocrinology & Metabolism has revealed a concerning paradox in the management of osteoporosis in the United States. While the use of drug therapies for the bone-weakening disease has increased over the last decade, a significant and persistent trend of underdiagnosis means millions of high-risk patients are missing out on vital treatment, leaving them vulnerable to debilitating fractures.
There are two ways osteoporosis is diagnosed: before or after a fracture. The former, or primary prevention, is done via bone density setting (e.g. a T score <-2.5) and the latter, secondary prevention, when a fracture has occurred. Professional societies differ in screening guidelines but typically bone density testing is recommended for women aged ≥65 years as well as younger postmenopausal women with histories of nontraumatic fractures and risk factors.
“Trends in Osteoporosis Drug Therapy Receipt Among Commercial and Medicare Advantage Enrollees in the United States, 2011-2022,” a retrospective analysis of over 166 million patient-quarter observations from commercial and Medicare Advantage health insurance data between 2011 and 2022, found a clear split in care. Among women aged 65 and older with an official diagnosis but without prior fragility fracture, prescription fill rates increased from 36.3% to 50.1%. Similarly, for those with an official diagnosis of osteoporosis who had already suffered a fragility fracture, which is a key indicator of underlying bone disease, the fill rate rose from 30.8% to 43.7%.
The study highlights a crucial disconnect: A fragility fracture should be a wake-up call for both patient and physician to investigate underlying bone health, yet it is frequently not. This underdiagnosis contributes directly to the underuse of medications that could prevent future, and potentially more severe, fractures.
This upward trend suggests that once osteoporosis is identified, doctors are increasingly prescribing the necessary medications to prevent future fractures. However, the study’s most alarming finding lies in what happens before a diagnosis is made. Researchers found that more than 70% of all patients who experienced a fragility fracture — a clear symptom of bone fragility and a diagnostic criterion of osteoporosis — did not have a corresponding diagnosis of osteoporosis in their medical records. In this case, fewer than one in eleven women received treatment.
This startling statistic points to a systemic failure in the healthcare system to properly screen and diagnose at-risk individuals. As a result, the very patients who most urgently need intervention are often overlooked. The study highlights a crucial disconnect: A fragility fracture should be a wake-up call for both patient and physician to investigate underlying bone health, yet it is frequently not. This underdiagnosis contributes directly to the underuse of medications that could prevent future, and potentially more severe, fractures.
The trend is further underscored by the fact that for patients with fragility fractures but no documented osteoporosis, the use of drug therapy declined between 2011 and 2022, from 9.2% to just 7.4%. This suggests that without an official diagnosis, doctors are less likely to initiate treatment, despite the obvious clinical evidence of bone fragility. The findings from this study confirm what many bone health experts have long feared: A significant gap exists in patient care that puts millions at risk. To change this trajectory, the authors state that healthcare community must prioritize greater awareness, systematic screening, and timely diagnosis of osteoporosis, especially for anyone who has suffered a fracture
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