Many high-risk post-menopausal women in the USA remain undertreated for osteoporosis

A large proportion of post-menopausal women in the USA who are at very high risk of fracture are either undertreated or receive oral bisphosphonates instead of other guideline-recommended therapies.

Dr Xiaodong Li (Amgen Inc., CA, USA) presented the results from a retrospective cohort study using Optum® Market Clarity Bone Data [1]. Eligible participants were post-menopausal women aged ≥55 years with a diagnosis of osteoporosis, or a history of fracture, or osteoporosis medication use, with at least 455 days of continuous database enrolment, and no history of Paget’s disease or metastatic cancer.

Two cohorts were defined:

• a treated cohort (initiated treatment between April 2019 and the end of September 2023), and
• an untreated cohort (no therapy initiation in the 15 months preceding January 2023).

Fracture risk status was classified using the American Association of Clinical Endocrinology (AACE) criteria.

Among the 41,597 treated participants, 56.3% received an oral bisphosphonate. Within this group, 12.6% had a recent fracture (≤12 months), of whom 41.5% were treated with an oral bisphosphonate. Among those without a fracture history but with a T-score ≤-3 (0.8%), 36.8% received an oral bisphosphonate, while among those with a very high-risk Fracture Risk Assessment Tool (FRAX) score (38.2%), 55.6% were receiving oral bisphosphonates. Overall, 51.7% of all very high-risk participants in the treated cohort (n=21,466) were receiving oral bisphosphonates. In the untreated cohort (n=318,140), 37.1% (n=118,065) met the criteria for a very high risk of fracture but were not receiving therapy.

“Among treated post-menopausal women with osteoporosis at very high fracture risk, more than half received oral bisphosphonates, which does not align with current guidelines recommendations for initial therapy,” concluded Dr Xiaodong. “Over 1/3 of untreated women with osteoporosis are at very high risk of fracture and are eligible for treatment with osteoanabolic therapies, denosumab, or zoledronic acid according to current guidelines.”

1. Chien HC, et al. Distribution of fracture risk status and osteoporosis treatment use among postmenopausal women with osteoporosis in the United States. ACR Convergence, 24–29 October 2025, Chicago, IL, USA.

Medical writing support was provided by Mihai Surducan, PhD.

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Posted on 31 October 202531 October 2025