Background: Postmenopausal women (PMW) with a fracture or low bone mineral density (BMD) are at elevated risk for a future fracture. Treatment to prevent fracture is recommended for these women. We evaluated utilization of osteoporosis treatment among participants in National Osteoporosis Risk Assessment (NORA) who were at high risk for fracture and whether treatment utilization differed by age, ethnicity, or education.

Methods: Women in NORA had no prior diagnosis of osteoporosis and were not on osteoporosis-specific treatment at the time of enrollment. However, hormone therapy (HT) was allowed. Both participants and their physicians received education on osteoporosis and its management and treatment. Between 5/99 and 6/00, 143,930 participants with baseline BMD measured at one peripheral site reported if they were currently taking osteoporosis-specific medication (alendronate, calcitonin, or raloxifene; risedronate was not yet available) at the time of the one-year follow-up survey. HT was not included as osteoporosis treatment since it was not known if participants were specifically prescribed this therapy for osteoporosis. A Chi-Square p-value of < 0.001 was considered significant, due to the large sample size of the cohort.

Results: Results by age and ethnicity are shown in Tables 1 and 2 below. Treatment rate was significantly lower in women age 50-59 years old and in women of African American ethnicity. Treatment rate did not differ significantly by education. Reported HT usage did not reduce the likelihood of osteoporosis-specific treatment.

Table 1: Treatment Rate by Age Group

	Overall	50 – 59	60 – 69	70 – 79	80+
1 Fracture (N= 2112)^	33	20.4	33.3	39.5	42.2
T≤-2.5 (N = 9,367) ^	55	56.0	57.4	56.6	49.3
2 NOF (N = 32,298)^	42	35.6	32.4	39.2	43.1
Any the above (N = 33,448) ^	41	33.8	41.1	44.2	42.9

Table 2: Treatment Rate by Ethnicity

	Overall	African American	Caucasian	Asian	Hispanic	Native American
1 Fracture (N= 2112)*	33	15.8	33.0	22.2	44.1	50.0
T≤-2.5 (N = 9,367) ^	55	38.2	55.9	60.5	51.5	52.3
2 NOF (N = 32,298)^	42	33.2	42.3	51.9	39.9	38.1
Any the above (N = 33,448) ^	41	32.2	41.5	51.3	39.2	39.2

1 Between baseline and 1-year follow-up survey

2 NOF treatment criteria: T-score < -2.0 or < -1.5 with ³ one risk factors including low body weight, personal or family history of fracture, and current smoker

^ P ≤ 0.0001; * P< 0.05 but ≥ 0.001 (Not Significant)

Conclusions: In NORA, despite physician and patient education on osteoporosis, less than one-half of women at increased risk for fracture, for whom interventions to reduce fracture should be considered, reported receiving treatment. Younger PMW and women of African American ethnicity reported even lower usage of treatment. In the primary care setting, there is room for improvement in the management of postmenopausal women at increased risk for osteoporotic fractures.