Consider Fracture Risk Data When Prescribing Preventive Drug Tx


NEW ORLEANS — Giving primary care physicians quantitative information about fracture risk can help them make more judicious use of preventive drug therapy for postmenopausal women at below-average risk for osteoporosis, Joan M. Neuner, M.D., said at the annual meeting of the Society of General Internal Medicine.

In a national survey targeting a random sample of primary care physicians, those who received lifetime and 5-year quantitative fracture risk estimates along with bone mineral density (BMD) reports were less likely than those given standard BMD reports to recommend preventive prescription drugs for a 70-year-old, average-weight woman with a T score of −1.01, Dr. Neuner reported.

The survey included nationally representative proportions of general internists, family physicians, general practitioners, and ob.gyns. The physicians were asked to respond to four clinical vignettes that varied with regard to patient age, weight, and hip BMD. The survey also included Likert-scaled items to measure osteoporosis knowledge, attitudes, and screening preferences.

Of the respondents, 141 randomly received standard hip BMD measures for each vignette (reported as g/cm

Dr. Neuner and her colleagues at the Medical College of Wisconsin in Milwaukee developed a logistic regression model to adjust the results for physician specialty, physician demographics, and physician estimates of relative fracture risk for a patient with below-average risk.

“In the unadjusted analysis, physicians who received augmented BMD reports were no more or less likely to recommend prescription medications for any of the vignettes,” Dr. Neuner said. In the adjusted model, however, 25% of the physicians who received the augmented BMD would have prescribed drug therapy for the below-average-risk 70-year-old, compared with 36% of the physicians who received the standard BMD report only—a statistically significant difference, she said.

Physicians in the standard BMD group who correctly identified the woman as having a below-average risk of hip fracture based on age, weight, and hip BMD also were less likely to recommend drug therapy, she added.

The findings suggest that adding quantitative fracture risk estimates to BMD reports “has the potential to change physician prescribing behavior” for women at low risk for osteoporosis. Similarly, educating primary care providers about risk classification could change their perceptions about who should get preventive drug therapy, Dr. Neuner said.

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