Changing trends in osteoporosis care from specialty to primary care physicians

Background: Inadequate treatment by non-specialty primary care physicians (PCPs) has been a concern in improving osteoporosis care. An increase in outpatient visits by older patients seeking osteoporosis care has been reported. But what percentages of these visits are made to PCPs are unknown. We investigated recent trends of outpatient visits and treatment for osteoporosis in older adults (>50 years) by physician type (PCPs vs. specialty care non-PCPs). Methods: A cross-sectional analysis used National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2002 to 2008 in the USA. Patients ≥50 years with osteoporosis were included. Descriptive and logistic analysis reported trends of visits and treatment for osteoporosis care by physician type. Results: About 9 million weighted visits were reported between 2002 and 2008. An increase in osteoporosis-related visits was noted from 5% in 2002 to 20% in 2008. The majority of patients in these visits were women (89%), between 65 and 84 years of age (56%), of non-Hispanic (88%) and White (81%) ethnic/racial backgrounds and had Medicare (51%) as the source of payment. Almost half (49.5%) of the visits were made to the PCPs. About 74% visits recorded a prescription for osteoporosis treatment. Calcium supplementation was low in the study population, and the lack of data on vitamin D supplements prevented us commenting on the supplementary aspect of osteoporosis management. Non-PCPs were more likely to have prescribed bisphosphonates (p<0.05) during an osteoporosis-related visit compared to PCPs (odds ratio:1.81, 95% CI: 1.12-2.92). Conclusions: We report a change with increasing trend of outpatient visits to PCPs for osteoporosis care since the 1990s. Despite a lower percentage of prescriptions by PCPs than non-PCPs, there is an increasing trend of prescribing osteoporosis treatment by PCPs. Growing demand for managing the chronic bone disease mandates a need for assessment of educational interventions to better prepare PCPs for improving skeletal health of the elderly.