Treatment pattern of Osteoporosis in Bangladesh

Abstract

Epidemiological studies have projected a vast increase in osteoporotic fractures in Bangladesh. Awareness of osteoporosis among medical professionals and the pattern of management in Bangladesh have not been explored. In the year, 2005; 147 doctors who were involved in treating osteoporosis, 69% doctors were specialists and 9% were consultants, to whom the questionnaire was distributed at this meeting, 115 questionn-aires were returned with a response rate of 78%. Eight surveys were excluded because of incomplete biographical information, resulting in a total of 107 completed questionnaires that for analysis. 84% attended any specialized osteoporosis program but only 24% had subscription in any medical journal or website. Bangladeshi doctors’ awareness of WHO criteria about T-score is 75% but 11% doctors were not aware. Approximately 59% doctors follow guideline and 22% do not follow any guideline but only 15% were able to write specific guideline name, 86% were unable to write the name of the following guideline. DXA was suggested by 25% doctors, 23% suggested plain radiography, 17% used CT skin imaging, 5% QUS, 10% MRI, 18% X-ray for diagnosis of osteoporosis. Plain radiography is useful for fracture prediction thought by 70% doctors, 51% of them selected CT scan as most sensitive diagnostic tool and CT scan is used by 31% doctors because of lower cost vs. DXA. 38% of them thought that DXA does not measure BMD directly, 36% used to predict fractures on postmenopausal women. For the prevention of osteoporosis, physical exercise was preferred by 19% doctors, 20% ticked on calcium rich diet, 15% on hormone replacement, 17% on calcium supplementation, and 17% on vitamin D supplementation. For the treatment purpose, most of the doctors; 15% used bisphosphonates, 12% calcium supplement, 11% estrogen, 10% estrogen agonist/ anta-gonist and very few doctors; 0.5% on vitamin C, 5% on chondroitin sulfate, 3% on sodium fluoride, 0.3% on others, 0.1% on combination, 6% on calcitonin, 6% on gluco-samine, 7% ticked on strontium ranelate, 8% on parathyroid hormone, 8% on calcitriol, 8% on tibolone. 27% doctors prescribed bisphosphonates, 22% calcitonin, and 26% estrogen for prevention of osteoporosis. This study showed that physicians in Bangladesh were moderately aware of osteoporosis, though the disease was still under-diagnosed due to inaccessibility and high cost of the diagnostic tools and therapeutic agents. So govern-ment and doctors should take initiative to increase the awareness of osteoporosis among the physicians in Bangladesh.