Underdiagnosis and Undertreatment of Osteoporosis: The Battle to Be Won
1Colorado Center for Bone Research, Lakewood, Colorado 80227.
Context:
An expert opinion perspective on why osteoporosis is underdiagnosed and undertreated.
Objective:
To highlight the potential reasons for why osteoporosis is undertreated.
Design:
Literature review from PubMed, Plos One, and Science Direct search engines from 1900-2015 under terms: sub-trochanteric and atypical femur fractures, bisphosphonate clinical trial and bisphosphonate review articles, and treatment/under treatment of osteoporosis, as well as personal experience.
Setting:
Careful and objective review.
Patients:
Derived from reviews.
Interventions:
Bisphosphonates.
Outcomes:
Atypical sub-trochanteric femur fractures.
Results:
Atypical sub-trochanteric femur fractures occur in both bisphosphonate and non-bisphosphonate users; and, bisphosphonate utilization has declined in temporal relationship with the reporting of these fractures associated with bisphosphonate use. There is no causality in this association and the benefit/risk ratio of bisphosphonates reducing all fracture risk vs the potential for the development of an atypical sub-trochanteric femur fracture is exceedingly in favor of bisphosphonate use in higher risk populations.
Conclusions:
Treatments for osteoporosis should not be stopped (e.g. the "drug-holidays") in higher risk patients since the basic pathophysiology of osteoporosis continues; and, the evidence linking bisphosphonate use to causing atypical sub-trochanteric femur fractures is non-existent.
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