The osteoporosis care gap in Canada

Abstract

BackgroundThe presence of a fragility fracture is a major risk factor for osteoporosis, and should be an indicator for osteoporosis diagnosis and therapy. However, the extent to which patients who fracture are assessed and treated for osteoporosis is not clear.MethodsWe performed a review of the literature to identify the practice patterns in the diagnosis and treatment of osteoporosis in adults over the age of 40 who experience a fragility fracture in Canada. Searches were performed in MEDLINE (1966 to January 2, 2003) and CINAHL (1982 to February 1, 2003) databases.ResultsThere is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. The proportion of individuals with a fragility fracture who received an osteoporosis diagnostic test or physician diagnosis ranged from 1.7% to 50%. Therapies such as hormone replacement therapy, bisphosphonates or calcitonin were being prescribed to 5.2% to 37.5% of patients. Calcium and vitamin D supplement intake was variable, and ranged between 2.8% to 61.6% of patients.ConclusionMany Canadians who experience fragility fracture are not receiving osteoporosis management for the prevention of future fractures.

Effectiveness of antiresorptives for the prevention of nonvertebral low-trauma fractures in a population-based cohort of women

“…"A care gap refers to a discrepancy between processes of care that have been defined as best practice on the basis of high-quality evidence and the care provided in usual clinical practice" [22]. The presence of a care gap has been documented extensively in the osteoporosis field [23,24]. Our results confirm, once again, the presence of an osteoporosis care gap in Canadian postmenopausal women.…”

Osteoporosis management among residents living in long-term care

“…The findings are of particular interest as these individuals are at high risk of falls and fractures [2]; 34% had experienced a fall in the last 180 days and 16% of fallers experienced a fracture. The findings of an osteoporosis care gap in LTC residents in Canada are consistent similar studies in the USA [20,21], with research conducted among home care recipients [15], and community-living individuals with fragility fractures in Canada [14] and internationally [13].…”

“…Use of osteoporosis medications prior to fracture was not included as a predictor in the current study as not all residents included had had a fracture. An increased likelihood of osteoporosis management among females has been reported previously among community-living individuals with fragility fractures [14,[38][39][40][41][42][43], among home care recipients [15] and among LTC residents in the USA [20,21]. Although gender was not a predictor of treatment in the current study, previous studies reporting that osteoporosis tends to be overlooked in males suggest the need to initiate osteoporosis investigation in males as well as females to ensure that at-risk males receive adequate management.…”

“…Calcium and vitamin D supplementation in combination can reduce the incidence of hip and nonvertebral fractures among institutionalized individuals [11,12]. Despite the availability of several therapeutic options for preventing fractures, many community-dwelling individuals at risk are not being diagnosed and treated for osteoporosis [13][14][15]. Although individuals living in LTC are at higher risk for fractures, the identification and treatment of osteoporosis among institutionalized individuals may be suboptimal [16][17][18][19].…”

Canadian Consensus Conference on Osteoporosis, 2006 Update

“…Despite availability of different evaluation techniques and diagnostic modalities, it has been estimated that only 5% to 25% of Canadian women with fragility fractures are subsequently investigated for osteoporosis, and only half of those receive treatment. 48,49 Fragility fracture is defined as a fracture that occurs spontaneously or following a minor trauma, such as a fall from standing height (e.g., a fall from roller skates or ice skates); a fall from a sitting position; a fall from laying down on a bed or a reclining deck chair from less than a meter high; a fall after having missed 1 to 3 steps in a staircase; a fall after a movement outside of the typical plane of motion; or coughing. Some studies have considered fractures that occur as a result of any fall from a height of less than a meter, such as after having missed 1 to 3 steps in a staircase, as fragility fractures.…”