In fact, most physicians fail to discuss osteoporosis with their patients, even after a fracture ( Pal 1999). Use of bone mineral density ( BMD) testing in this population ranges from 3–23 percent, while use of calcium and vitamin D supplementation ranges from 11–44 percent, and use of antiresorptive therapy ranges from 12–16 percent ( Morris et al. As a result, most high-risk individuals (e.g., those who have suffered a fragility fracture) do not get the testing and treatment that they need.
Just as for the use of diagnostic measures, numerous studies indicate that there has been a failure in the United States to apply preventive and treatment measures to many persons at risk for bone disease. In particular the introduction of bisphosphonates and selective estrogen receptor modulators (SERMs) has given health care providers new approaches to therapy. Just as there have been great advances in the ability to identify individuals at risk of fracture (see Chapter 8), there have been equally important advances in the ability to prevent and treat fractures in these individuals, especially those with skeletal fragility. For all of these conditions, early detection and treatment are critical to avoiding crippling deformities and fractures. Treatment is also available for some congenital bone disorders and for bone disease associated with kidney failure. Specific, effective treatments exist for a number of bone diseases other than osteoporosis, including hyperparathyroidism, rickets, and osteomalacia.
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