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Improving osteoporosis screening, risk assessment, diagnosis, and treatment initiation: role of the health-system pharmacist in closing the gap.

PURPOSE
To describe the epidemiology of osteoporosis and related fractures in the United States, morbidity and mortality from the disease, the gap between evidence and practice related to screening and treatment, and new approaches to risk assessment and treatment decisions.


SUMMARY
Osteoporosis-related fractures are a significant cause of disability, pain, and even death. Fractures are more common in women than men, but men also are affected. Screening for and treatment of osteoporosis are inadequate, so bone health initiatives have been developed to begin addressing this problem. The diagnosis of osteoporosis is based on bone mineral density (BMD) as assessed by dual-energy X-ray absorptiometry (DXA). While BMD is an important factor in assessing bone strength, other factors such as advanced age and various lifestyle, genetic, and disease- and medication-related factors are also important in assessing fracture risk. The National Osteoporosis Foundation (NOF) has published recommendations to guide decisions about BMD testing and treatment to reduce fracture risk. The NOF publication incorporates a fracture risk assessment tool from the World Health Organization (WHO) that facilitates treatment decision making.


CONCLUSION
Health-system pharmacists can improve outcomes in patients with or at risk for osteoporosis by collaborating with physicians and other members of the health care team in osteoporosis screening, risk assessment, diagnosis, and treatment.