The profile of patients referred to the Moscow Regional Osteoporosis centre

Abstract

Background: The expected ageing of the population and the increase in the number of patients with osteoporosis require a correct approach to identification of individuals with a high fracture risk, to their rational routing for the work-up and timely prescription of therapy. A preliminary analysis of characteristics of patients referred to specialized osteoporosis centers may help to optimize medical care for these patients. Aim: To analyze the profile of patients referred for densitometry and/or to an osteoporosis specialist at the Moscow Regional Osteoporosis Centre in order to optimize care for this patient population in the region. Materials and methods: The study was performed in the Moscow Regional Osteoporosis Centre located in Moscow Regional Research and Clinical Institute (MONIKI). We retrospectively analyzed medical files of all consecutive outpatients attending the center at their own or with a referral for densitometry and/or specialist consultation January 1 to December 31, 2019. Results: The study included 1940 patients aged 42 to 90 years, with 96.5% (n = 1873) being female, with the mean age of 65.4 8.5 years; males accounted for 3.5% (n = 67), their mean age was 65.6 9.0 years. Patients who had not previously been diagnosed with osteoporosis accounted for 63.8% (n = 1238), whereas 36.2% (n = 702) of the patients have been diagnosed earlier. 27.8% (n = 540) of all patients, were remarkable for the history of low-energy fractures. 88.1% of the patients were referred by endocrinologists or rheumatologists. The main purpose of the referral was to perform densitometry and get the prescription of treatment for osteoporosis (61%). The median FRAX-based risk of major fractures in the total group was 8.2 [6.9; 13.0] % (n = 1277), with the risk in women being significantly higher than in men (8.3 [7; 13] % vs. 4.6 [4.2; 7.7] %, respectively, p 0.001). When bone mineral density was assessed with the T-score (n = 1928), the result of +0.1 SD was found in 6.6% (n = 127), whereas 11.6% (n = 224), 44.4% (n = 856), 37.4% (n = 721) were judged as normal values, osteopenia, and osteoporosis, respectively. According to the specialist consultation in the Centre, a clinical diagnosis of osteoporosis was made in 53.2% of the cases (n = 1032), while 0.3% (n = 5) had another bone disease, 19.2% (n = 373) had no bone disease, and 27.3% (n = 530) had some other problems. The proportion the patients with indications for treatment for osteoporosis was 56% (n = 1089); 45% (n = 489) of them were recommended to initiate therapy, 36.7% (n = 400) continued with their previous medication and 18.3% (n = 200) needed a modification of their management. Conclusion: The study results have shown that patients are frequently referred for densitometry without enough grounds and with a low risk of fracture. This makes highly relevant the use of the FRAX algorithm as a screening tool for diagnosis and timely administration of treatment for osteoporosis not only by specialists, but also by primary care physicians.