Primary care physicians’ views on osteoporosis management: a qualitative study

Abstract

Summary Osteoporosis is an under-diagnosed condition; only around 14% of patients in Sweden receive bone-specific treatment after a fragility fracture. This qualitative interview study found that primary care physicians perceive osteoporosis as a silent disease that is overshadowed by other conditions and is complicated to manage. Purpose To explore primary care physicians’ views on managing osteoporosis. Methods A total of 17 primary care physicians in Stockholm participated in four focus group interviews. Interview transcripts were analysed with thematic analysis. Results One main theme was found: Osteoporosis—a silent disease overshadowed by other conditions . The main theme contained five sub-themes. Physicians perceived osteoporosis as a low-priority issue. They described uncertainty about managing it and insufficient awareness of the condition in primary healthcare (PHC). Physicians had differing opinions about who is responsible for managing osteoporosis. They reported that the health care system regulated their work such that they gave low priority to the condition. They were uncertain about the value of the Fracture Risk Assessment Tool (FRAX). The physicians thought that financial incentives, education, and increased collaboration with other relevant health care professionals and with patients were needed to increase the priority of osteoporosis in PHC. Conclusion Physicians perceived osteoporosis as a silent disease that is complicated to manage. They gave low priority to osteoporosis and thought their patients shared this view. The physicians saw other issues and medical conditions as more important than osteoporosis. They wanted better collaboration at their PHC centres and with hospitals. They also wanted district nurses to be more involved in managing osteoporosis and especially in assessing fracture risk.

Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation

“…Osteoporosis underdiagnosis and undertreatment contribute to fractures and mortality among older adults, despite validated risk stratification tools to identify patients at risk of fracture [ 1 ] and medications to reduce this risk [ 2 ]. Prior research has identified many contributing factors to the low rates of osteoporosis screening and treatment, including differing clinical guidelines for identifying patients with indication for dual-energy X-ray absorptiometry (DXA) screening of bone mineral density (BMD) [ 3 – 6 ]; reimbursement policies; limited time during clinic visits to complete fracture risk assessment using existing stratification tools; and limited provider understanding of risk [ 7 , 8 ]. Organizational and education barriers may be overcome by using an informatics approach to identify patients with un-assessed fracture risk on the basis of their electronic health record data.…”

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

“…The secondary fracture prevention gap described here may have been influenced by several factors documented in recent studies including: insufficient communication from the fracture clinic informing family doctors of their patient incurring a fragility fracture and of high fracture risk (if present) [49]; not incorporating initiation of osteoporosis treatment into discharge order sets following hip fracture [50]; deprioritization of osteoporosis management over other chronic diseases in primary care potentially due in part to underestimation of the consequences of fragility fractures on morbidity and mortality in elderly people [51]; lack of urgency around secondary fracture prevention by utilizing 10 year fracture risk instead of imminent fracture risk [7]; the overreliance on densitometric osteoporosis diagnosis thresholds (BMD T-score of ≤ − 2.5) for therapy initiation rather than history of fracture [52,53]; lack of guidance surrounding the benefit of osteoporosis treatment and the risk of rare adverse events from these treatments (ie, atypical femoral fractures and osteonecrosis of the jaw; < 80 per 100,000 person-years) [7,54]; and overestimated concerns of these rare events by other specialties (i.e., dentists concerned with osteonecrosis of the jaw [54,55]). Current efforts are urgently needed to help address the secondary prevention care gap and its contributors, as part of new guidelines development, advocacy measures, and other initiatives (eg, FLS) [11,13,53,54,56].…”

The assessment and pharmacological management of osteoporosis after admission for minimal‐trauma fracture at a major metropolitan centre

“…17 Even in general practice settings confusion exists about responsibility for managing osteoporosis, with osteoporosis considered a low-priority issue, resulting in community patients being undertreated. [25][26][27] There remains a need for therapeutic guidelines to suggest the commencement of osteoporosis management in acute settings, with consensus provided from surgical and other acute clinical groups.…”

“…The development of the national osteoporosis guidelines in collaboration with the Royal Australian College of General Practitioners may contribute to the notion that osteoporosis should be treated by GPs, however the intent was for hospital and community practitioners to work in unison 17 . Even in general practice settings confusion exists about responsibility for managing osteoporosis, with osteoporosis considered a low‐priority issue, resulting in community patients being undertreated 25–27 . There remains a need for therapeutic guidelines to suggest the commencement of osteoporosis management in acute settings, with consensus provided from surgical and other acute clinical groups.…”