Gynecologists Are Not Routinely Assessing Bone Health


Middle-aged women aren't being routinely assessed for osteoporosis during their ob.gyn. visits, despite this group's increased awareness of the condition, survey results released by the North American Menopause Society showed.

In a poll of 881 women, most of whom were either perimenopausal or postmenopausal, nearly all (98%) said they considered bone strength to be an important health concern. But 45% reported that osteoporosis was not addressed during their last routine ob.gyn. visit, and 26% said they had never discussed osteoporosis with their gynecologist.

Dr. Wulf H. Utian, the honorary founding president and executive director emeritus of the North American Menopause Society (NAMS), said that the survey shows there is more work to be done in raising awareness among ob.gyns. but that the results aren't a cause for concern. “Some important issues don't get attention during the consultation, and that may be a reflection of modern medicine and the limited time that's available,” he said in an interview.

In fact, Dr. Utian said both the public and health care providers have significantly greater awareness of osteoporosis and bone health than they did only a decade ago.

But there are barriers to making bone health a regular part of ob.gyn. care, he said. One issue is a lack of reimbursement for performing bone density testing. In some instances, physicians may not be recommending bone density testing because they think it won't be reimbursed, and they believe they can get an adequate risk assessment without the test.

In other cases, physicians are recommending bone density testing, but patients are rejecting it because they will have to pay out of pocket, Dr. Utian said. In fact, the survey found that even though nearly 63% of women reported that their ob.gyn. had recommended a bone scan, 27% of women surveyed had never had one.

Another barrier is the confusion among physicians about who should get a bone density test. There has been a good deal of variation among the recommendations coming out of various medical organizations, Dr. Utian said, creating a sense of uncertainty. In an effort to spell out more clearly the appropriate diagnosis, prevention, and treatment for postmenopausal osteoporosis, NAMS recently issued a new position statement on osteoporosis in midlife (February 2010, p. 1.).

In the position statement, NAMS recommends the use of the World Health Organization's FRAX (Fracture Risk Assessment) tool as well as increased vitamin D3 intake. NAMS plans to take the scientific paper, which was issued last month, and translate it into a series of consumer education pieces, he said.

The NAMS survey also points to a possible communication gap between women and their ob.gyns. about the risk factors for osteoporosis. For example, among the women surveyed, 45 women said they had a broken bone in the past 5 years that occurred in a site associated with osteoporosis such as the hip, spine, wrist, collarbone, arm, leg, or pelvis. However, 35 of those women said their ob.gyn. was not aware of the break.

Additionally, while most women surveyed said that their ob.gyns. had told them that broken bones could be a sign of osteoporosis, the women were not as well informed about other possible consequences, including loss of height, dowager's hump, and disability or immobility.

The survey results could indicate that physicians are failing to take an adequate history during routine exams, Dr. Utian said. It also could mean that patients are failing to understand the association between bone fracture and menopause. “In other words, the woman doesn't tie the fact that she's had a fracture with anything that's to do with her visit to the gynecologist,” he said.

Dr. Utian said that all gynecologists who see women in their middle years should routinely ask about risk factors for bone loss and fracture.

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