Osteoporosis International

, Volume 22, Issue 3, pp 789–796

Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study

  • L.-A. Fraser
  • G. Ioannidis
  • J. D. Adachi
  • L. Pickard
  • S. M. Kaiser
  • J. Prior
  • J. P. Brown
  • D. A. Hanley
  • W. P. Olszynski
  • T. Anastassiades
  • S. Jamal
  • R. Josse
  • D. Goltzman
  • A. Papaioannou
  • the CaMos Research Group
Original Article

DOI: 10.1007/s00198-010-1359-2

Cite this article as:
Fraser, LA., Ioannidis, G., Adachi, J.D. et al. Osteoporos Int (2011) 22: 789. doi:10.1007/s00198-010-1359-2

Abstract

Summary

Canadian women over 50 years old were studied over a 10-year period to see if those who sustained a fracture (caused by minimal trauma) were receiving the recommended osteoporosis therapy. We found that approximately half of these women were not being treated, indicating a significant care gap in osteoporosis treatment.

Introduction

Prevalent fragility fracture strongly predicts future fracture. Previous studies have indicated that women with fragility fractures are not receiving the indicated treatment. We aimed to describe post fracture care in Canadian women using a large, population-based prospective cohort that began in 1995–1997.

Methods

We followed 5,566 women over 50 years of age from across Canada over a period of 10 years in the Canadian Multicentre Osteoporosis Study. Information on medication use and incident clinical fragility fractures was obtained during a yearly questionnaire or interview and fractures were confirmed by radiographic/medical reports.

Results

Over the 10-year study period, 42–56% of women with yearly incident clinical fragility fractures were not treated with an osteoporosis medication. During year 1 of the study, 22% of the women who had experienced a fragility fracture were on treatment with a bisphosphonate and 26% were on hormone therapy (HT). We were not able to differentiate HT use for menopause symptoms vs osteoporosis. Use of bisphosphonate therapy increased over time; odds ratio (OR) for use at year 10 compared to use at year 1 was 3.65 (95% confidence interval (CI) 1.83–7.26). In contrast, HT use declined, with an OR of 0.07 (95%CI 0.02–0.24) at year 10 compared to year 1 of the study.

Conclusion

In a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures. Although bisphosphonate therapy usage improved over time, a substantial gap remains.

Keywords

BisphosphonatesCare gapFragility fractureOsteoporosisPostmenopausal women

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • L.-A. Fraser
    • 1
  • G. Ioannidis
    • 1
  • J. D. Adachi
    • 1
  • L. Pickard
    • 1
  • S. M. Kaiser
    • 2
  • J. Prior
    • 3
  • J. P. Brown
    • 4
  • D. A. Hanley
    • 5
  • W. P. Olszynski
    • 6
  • T. Anastassiades
    • 7
  • S. Jamal
    • 8
  • R. Josse
    • 8
  • D. Goltzman
    • 9
  • A. Papaioannou
    • 1
  • the CaMos Research Group
  1. 1.Departments of Epidemiology and Medicine, Hamilton Health Sciences—Chedoke SiteMcMaster UniversityHamiltonCanada
  2. 2.Department of MedicineDalhousie UniversityHalifaxCanada
  3. 3.Department of MedicineUniversity of British ColumbiaVancouverCanada
  4. 4.Department of MedicineLaval UniversityQuebec CityCanada
  5. 5.Department of MedicineUniversity of CalgaryCalgaryCanada
  6. 6.Department of MedicineUniversity of SaskatchewanSaskatoonCanada
  7. 7.Department of MedicineQueen’s UniversityKingstonCanada
  8. 8.Department of MedicineUniversity of TorontoTorontoCanada
  9. 9.Department of MedicineMcGill UniversityMontrealCanada