Challenges in Osteoporosis Awareness and Management: Results from a Survey of US Postmenopausal Women

Introduction Osteoporosis-related fractures are a serious public health burden leading to excess morbidity, excess mortality, and high costs for postfracture care. Risk evaluation and timely disease management are of paramount importance to improve long-term health outcomes. Objectives To evaluate perception of osteoporotic fracture risk in a population of US postmenopausal women and gain insight on challenges in diagnosis and treatment. Methods An online survey of US postmenopausal women ≥50 years of age (n=1,012) was conducted by Harris Poll in collaboration with the National Osteoporosis Foundation (NOF) and Healthywomen between March 31 and April 17, 2017. A weighted sample of US census including those with and without osteoporosis was used. The survey was designed to evaluate postmenopausal women's understanding of osteoporosis and its link to fractures. Results Approximately 50% of survey participants (501 of 1,012) were postmenopausal women with a self-report of physician diagnosis of osteoporosis (PMO), and half of those (250 of 501) were ≥65 years of age. Among all surveyed women, the most common self-reported comorbidities were hypertension, thyroid disease, respiratory disease, and diabetes. Fifty-six percent (280 of 501) of PMO and 20% (99 of 511) of women who did not report having a PMO diagnosis experienced a fragility fracture. Of women who experienced a fragility fracture, the majority received initial care in the emergency room or by primary care physicians. The majority (96%) of women with a first fracture did not recall being told by their physician that their fracture may be related to osteoporosis. Subsequent to the diagnosis of a fragility fracture, about a third of the women were not being referred for a follow-up visit; this varied by the specialty (orthopedic surgeons: 44%; primary care physicians /geriatricians (22%); emergency room physicians (18%). The majority (55%) of survey participants disagreed that a fracture is a potential sign of more fractures to come; some believed that only hip and back fractures are associated with osteoporosis. Conclusion These survey results reveal lack of awareness of osteoporotic fracture risk among postmenopausal women. There is poor understanding that a fragility fracture may be indicative of osteoporosis and that it increases future fracture risk. More education is needed among postmenopausal women to recognize that a fracture is a sentinel event that requires further evaluation and interventions to reduce the risk of subsequent fractures.