Postmenopausal osteoporosis risk management in primary care: how well does it adhere to national practice guidelines?

The National Osteoporosis Foundation (NOF) practice guideline provides explicit recommendations for postmenopausal osteoporosis risk assessment and management. This study evaluated primary care adherence to the recommendations and factors associated with such adherence.

Postmenopausal women 40 years old and older were sampled in the primary care clinic of a US tertiary hospital. We received 469 completed questionnaires that measured the respondent's demographics and osteoporosis risk factors; current and historical osteoporosis counseling, testing, and treatment; and whether or not she had a primary care clinician. Based on information provided, we determined whether each woman was receiving care that followed the NOF guideline. Univariate and multivariate analyses identified factors associated with guideline adherence.

Mean age was 69 years; 53% were white and 38% black; 15% had prior fractures. Using NOF criteria, 19.8 % were at moderate risk and 80.2 % were at high risk for osteoporosis. Overall, 57.6% (95% confidence interval 53.1, 62.1) of patients received risk management in accordance with the NOF guideline. The adherence rate was higher in the high-risk group (60.9% v 44.1%, p=.003), in those who had primary care clinicians (62.0% v 43.5%, p=.006), and in nonblack patients (white v black 67.1% v 43.0%, p<.001; other v black 65.0% v 43.0%, p=.012). These associations remained statistically significant after multivariate adjustments. Adherence was not associated with the sex of the primary care clinician.

More than half of postmenopausal women in our study were receiving osteoporosis risk management that followed the NOF practice guideline. Those who were at higher risk, who were not black, or who had primary care clinicians were more likely to receive care in accordance with the NOF guideline, regardless of the sex of the clinician.