Year in Review: Top Osteoporosis Articles of 2020

As part of our Year in Review series, Endocrinology Network’s editorial staff has put together a curated list made up of the most viewed and clinically impactful stories from various fields in endocrinology—this article is centered around advances in osteoporosis.

While 2020 has been a year where headlines were dominated by coronavirus disease 2019 (COVID-19), the risk of osteoporosis and subsequent fractures has persisted and many clinicians fear the silent progression of osteoporosis may have taken a back seat during the pandemic. Here is our list of the top 5 osteoporosis stories on Endocrinology Network from 2020.

Hormone Therapy Decreases Fracture Risk in Postmenopausal Women

Presented at the WCO-IOF-ESCEO 2020 virtual congress in August, results of the study suggested women who underwent hormone therapy with estrogen or estrogen plus progestin was experienced a 28% reduction in all fractures and a 34% reduction in osteoporotic fractures over the 8-year follow-up.

Conducted by clinicians from Sahlgrenska University Hospital in Sweden, investigators used data from more than 24,000 women in the Women's Health Initiative Hormone Therapy trials to compare the effects of placebo therapy vs estrogen alone or estrogen plus progestin. Upon conclusion of the trial, hormone therapy was associated with a significant reduction in the risk of any clinical fracture, major osteoporotic fracture, osteoporotic fracture, and hip fracture.

DOACs Tied to Lower Osteoporotic Fracture Risk than Warfarin

In July, a study published in the Annals of Internal Medicine did a deep dive and examined the impact of using direct oral anticoagulants vs warfarin on risk of fracture in patients with atrial fibrillation. While it may not grab headlines in the same manner as other topics in osteoporosis, the potential for increased fracture risk with DOACs has persisted for years.

Results of this study could serve to mitigate concerns over this risk, with results indicating apixaban, dabigatran, and rivaroxaban were all associated with a reduced risk of osteoporotic hip and vertebral fractures when compared against warfarin. AN analysis of EMR data from 23,515 patients with atrial fibrillation, investigators also determined there was no differential fracture risk between DOACs examined.

COVID-19 Pandemic Slashed Global Rate of FRAX Assessments by More than 50%

Medical facilities across the world were shuttered or forced to operate on skeleton crews during the peaks of the COVID-19 pandemic and this has caused unexpected ripples throughout various fields of care, including osteoporosis. To outline how evident this reduction in visits was, Eugene McCloskey, MD, and a team from the University of Sheffield performed an analysis of FRAX score use during the pandemic.

An analysis of GoogleAnalytics metrics from before and during the pandemic, results suggested the rate of FRAX scoring dropped more than 50% and investigators determined more than 500,000 patients could have been excluded from FRAX scoring as a result of missed or cancelled visits.

Osteoporosis is being Underdiagnosed, Undertreated in Older Men

“Men are typically not part of routinely recommended screening with dual-energy X-ray absorptiometry (DXA) and so they are both underdiagnosed and undertreated.”

That quote from Jeffrey Curtis, MD, summarizes the reason behind conducting this study, which was presented at the ACR Convergence 2020. Oftentimes, osteoporosis is considered to be a disease that only impacts aging white women and this has contributed to undertreatment and underdiagnosis in men.

An analysis of more than 9800 Medicare beneficiaries who had recently suffered a fracture, results indicated just 6% of male patients underwent a bone mineral density test with DXA in the 2 years leading up to their fracture. Adding to the concern, investigators found more than 60% had complaints of musculoskeletal pain in the year leading up to their fracture.

Three-Year Bone Density Follow-ups Do Not Increase Risk Prediction Accuracy

Often considered a routine part of follow-up care for aging women, a study published in JAMA Internal Medicine from July found 3-year bone density follow-ups may not be effective and go as far as to suggest they could be a misuse of resources.

An analysis of more than 7400 women from within the Women’s Health Initiative, the study concluded a second BMD assessment after initial measurement did not improve the accuracy of fracture risk assessment beyond the initial assessment and these follow-ups should not be routinely performed in postmenopausal women.