Abstract
Summary
This study reviewed factors influencing osteoporosis management in primary care settings in Australia and examined risk profiles of patients (n = 37,957) for osteoporosis. Only 29.7% of patients with a prior fracture were currently on specific medication for osteoporosis. The results highlight the need for further exploration of barriers to osteoporosis management.
Introduction
Osteoporosis management in primary care is suboptimal even for high-risk people with a history of prior fracture.
Methods
This study reviewed factors influencing the management of individuals at risk for osteoporosis in primary care settings in Australia and examined risk profiles of patients for osteoporosis. Patients (n = 37,957, mean age 71) were recruited over a 12-month period (February 2006–Jan 2007) and interviewed.
Results
With regard to risk factors for osteoporosis, 12.6% of patients reported a history of prior minimal trauma fracture, 7.5% reported a family history of osteoporosis, 7.4% reported they were current smokers, 11.4% reported low dietary calcium intake, 31.8% reported no regular weekly physical exercise and 10.3% reported current use of glucocorticoids. Of those with a prior fracture, only 29.7% were currently on specific medication for osteoporosis. Radiography (n = 17,754) demonstrated a prior vertebral fracture in 30.1%, but only 3.8% of the 17,754 patients reported current use of specific osteoporosis medication.
Conclusions
This study has confirmed low rates of treatment in primary care even in individuals who have already suffered a prior fracture or have other risk factors. This study highlights the need for further exploration of barriers to osteoporosis management in the primary care setting.
References
Sambrook P, Seeman E, Phillips S, Ebeling P (2002) Preventing osteoporosis—outcomes of the Australian Fracture Prevention Summit. Med J Aust 176(Suppl):S1–S16
Osteoporosis Australia (2007) The burden of brittle bones: epidemiology, costs and burden of osteoporosis in Australia. (http://www.arthritisvic.org.au/downloads/Burden%20of%20brittle%20bones.pdf)
Norton R, Campbell AJ, Lee-Joe T et al (1997) Circumstances of, falls resulting in hip fractures among older people. J Am Geriatr Soc 45(9):1108–1112
Sanders KM, Nicholson GC, Ugoni AM et al (1999) Health burden of hip and other fractures in Australia beyond 2000. Projections based on the Geelong Osteoporosis Study. Med J Aust 170:467–470
World Health Organization (2007) Assessment of osteoporosis at the primary health care level. Geneva: WHO. (http://www.who.int/chp/topics/rheumatic/en/index.html)
Kanis JA, Johnell O, Oden A et al (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397
Ross PD, Davis JW, Epstein RS et al (1991) Pre-existing fractures and bone mass predict vertebral fracture in women. Ann Int Med 114:919–923
Cummings SR, Nevitt MC, Browner WS et al (1995) Risk factors for hip fractures in white women. N Engl J Med 332:767–773
Robinson CM, Royds M, Abraham A et al (2002) Refractures in patients at least 45 years old. J Bone Jt Surg 84:1528–1533
Gunnes M, Mellstrom D, Johnell O (1998) How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal women. Acta Orthop Scand 69(5):508–512
Klotzbuecher CM, Ross PD, Landsman PB et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739
Zochling JM, Schwarz JM, March L et al (2001) Is osteoporosis undertreated after minimal trauma fracture? Med J Aust 174:663–664
Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163:819–822
Kamel HK, Hussain MS, Tariq S et al (2000) Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 109:326–328
Al-Allaf AW, Pal B, Reid N (1998) An audit of post fracture rehabilitation with special emphasis on osteoporosis assessment and treatment. Clin Exp Rheum 16:451–453
Freedman KB, Kaplan FS, Bilker WB et al (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82:1063–1070
Torgerson DJ, Dolan P (1998) Prescribing by general practitioners after an osteoporotic fracture. Ann Rheum Dis 57:378–379
Eisman J, Clapham S, Kehoe L (2004) Osteoporosis prevalence and levels of treatment in primary care: the Australian BoneCare Study. J Bone Miner Res 19:1969–1975
Solomon DH, Polinski JM, Stedman M et al (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22:362–367
Majumdar SR, Johnson JA, McAlister FA et al (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ 178:569–575
Taylor JC, Sterkel B, Utley M et al (2001) Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management. Osteoporos Int 12:844–848
Jaglal SB, Carroll J, Hawker G et al (2003) How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician 49:462–468
Kamalakanthan, Abhaya and Jackson, Sukhan (2006) The supply of doctors in Australia: Is there A shortage? Discussion paper No. 341, School of Economics, The University of Queensland. (http://eprint.uq.edu.au/archive/00004125/01/econ_dp_341_06.pdf)
Acknowledgments
This study was supported by a research grant from Osteoporosis Australia.
Conflicts of interest
Philip Sambrook serves on a Merck Advisory Board and has received speaker fees from Merck. Greg Lyubomirsky is a director of Merck Sharp & Dohme-Asia Pacific.
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Chen, J.S., Hogan, C., Lyubomirsky, G. et al. Management of osteoporosis in primary care in Australia. Osteoporos Int 20, 491–496 (2009). https://doi.org/10.1007/s00198-008-0686-z
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DOI: https://doi.org/10.1007/s00198-008-0686-z