2000 WHRG Grant Program

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National Patterns in Osteoporosis Management in Postmenopausal Women

Eun-Kyung Lee, Ph.D.
School of Pharmacy, University of Maryland, Baltimore

Osteoporosis is a systemic disease and a major public health problem affecting more than 25 million people. Of those 25 million with osteoporosis, 80 percent are women (National Institute on Aging, 1999). If not prevented or if left untreated, osteoporosis can lead to permanent disability or even death. Prevention of osteoporosis is of most importance, since there are no effective methods for restoring high quality bone to the osteoporotic skeleton (Consensus Development Conference, 1993). Recently published Physician's Guide recommends to counsel all patients on an adequate intake of calcium and vitamin D, regular weight-bearing exercise and avoidance of tobacco use to maximize and preserve bone mass (National Osteoporosis Foundation, 1998). The prevention of fall-related injuries of the elderly is also a national health objective for the year 2000 (Healthy People 2000 review, 1998-9. 1999). Therefore, we propose to investigate the national patterns of osteoporosis management with medications and counseling on health behavior by physicians among women 40 years of age and over.

Women, 40 years or older, are selected for our study because a Gaussian distribution of menopause ranges from age 40 to 58 years (Lobo, RA, 2000). In addition, osteoporosis is more prevalent among postmenopausal women and the prevention of osteoporosis needs to be emphasized from age 40 or over. The aims of osteoporosis management on those age groups are to intervene on osteoporotic patients with treatment and to guide patients with high risk with preventive management including health behaviors to reduce the risk of fracture (Menuier PJ et al., 1999). Therefore, our study is designed to evaluate the use of medications for osteoporosis prevention as well as treatment. We also propose to investigate the counseling provided by physicians regarding risks for osteoporosis and fracture such as diet/nutrition, smoking cessation, exercise, and fall prevention. Anti-osteoporosis medications (AOMs) included in this study are selected based on the literature review with the evidence of decreasing bone loss and fracture and the published clinical guidelines. They are thiazide diuretics, vitamin D, estrogen replacement therapy (ERT), selective estrogen receptor modulators, bisphosphonates, calcitonin, and calcium supplements. ERT is considered the agent of choice in osteoporosis management for postmenopausal women and has demonstrated beneficial effects on lipid profile and cardiovascular protection. However, ERT is contraindicated in patients with breast cancer, endometrial cancer, ovarian cancer, and thromboembolic disorders. To examine the relationship between AOM therapy and the disease conditions of the patient, we also propose to determine predictors of specific AOM therapy.

The National Ambulatory Medical Care Survey (NAMCS) from the National Center of Health Statistics (NCHS) will be used in our study as a data source. NAMCS collected data on the utilization of ambulatory care services by office-based physicians. We propose to use the combined data from 1997 and 1998, because the number of visits associated with AOMs on 1997 is small. We are informed that 1998 data will be available by the end of April 2000 (per personal communication with Dr. Woodwell from NCHS). NAMCS data are a valuable tool to provide national rates of practice patterns and medication use. There are no published studies which directly examined the patterns of osteoporosis management using NAMCS data. This study will characterize postmenopausal women's use of medical care for osteoporosis management in the ambulatory setting and clinical decision-making related to medication use across the U.S. Findings will be used to generate hypotheses and to support an application for studies on drug therapy for osteoporosis among women in primary care setting.