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J Clin Endocrinol Metab. 2016 Mar;101(3):852-9. doi: 10.1210/jc.2015-3156. Epub 2016 Feb 24.

Underdiagnosis and Undertreatment of Osteoporosis: The Battle to Be Won.

Author information

1
Colorado Center for Bone Research, Lakewood, Colorado 80227.

Abstract

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.

PMID:
26909798
DOI:
10.1210/jc.2015-3156
[Indexed for MEDLINE]

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