The osteoporosis care cascade in postmenopausal women with and without cardiovascular disease: a nationally representative cross-sectional study using dual-energy X-ray absorptiometry.

UNLABELLED: No study has used measured bone mineral density (BMD) data to compare osteoporosis care gaps between women with and without cardiovascular disease. Among 5,420 postmenopausal women with dual-energy X-ray absorptiometry (DXA), 71.1% with osteoporosis were undiagnosed and 87.2% untreated; cardiovascular disease history did not narrow these care gaps.

PURPOSE: No population-based study has used measured bone mineral density (BMD) data to compare the osteoporosis care cascade between women with and without cardiovascular disease (CVD). This study quantified the dual-energy X-ray absorptiometry (DXA)-based care cascade in South Korean postmenopausal women and tested whether CVD history is associated with care gaps.

METHODS

Data were from the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011 (n = 5,420 women aged ≥50 years with valid DXA). Osteoporosis was defined as a minimum T-score ≤ -2.5. CVD was defined as self-reported physician-diagnosed stroke, myocardial infarction, or angina pectoris. Multivariable logistic regression identified predictors of unawareness and non-treatment.

RESULTS

Of 5,420 women, 1,957 had DXA-confirmed osteoporosis (weighted prevalence, 34.0%); weighted awareness was 28.9% and treatment 12.8%. Awareness (35.7% vs. 28.4%, p = 0.084) and treatment (16.5% vs. 12.6%, p = 0.238) did not differ between CVD and non-CVD groups. After adjustment, CVD history was not associated with unawareness (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.51-1.12; p = 0.162) or non-treatment (OR 0.79; 95% CI 0.46-1.37; p = 0.403). Dyslipidemia was independently linked to lower odds of both unawareness and non-treatment.

CONCLUSION

In this cohort, 71.1% of women with T-score ≤ -2.5 had no prior physician diagnosis of osteoporosis, and only 12.8% were on medication. The CVD and non-CVD groups did not differ in awareness or treatment rates, suggesting that cardiovascular follow-up does not facilitate osteoporosis detection.