Original Article

Osteoporosis International

, Volume 20, Issue 11, pp 1911-1919

Factors influencing the treatment of osteoporosis following fragility fracture

  • L. BessetteAffiliated withDepartment of Medicine, CHUL Research Centre, Laval University Email author 
  • , S. JeanAffiliated withInstitut National de Santé Publique du Québec
  • , K. S. DavisonAffiliated withDepartment of Medicine, CHUL Research Centre, Laval University
  • , S. RoyAffiliated withInstitut National de Santé Publique du Québec
  • , L.-G. Ste-MarieAffiliated withDepartment of Medicine, Centre de Recherche du CHUM, Hôpital Saint-Luc, University of Montreal
  • , J. P. BrownAffiliated withDepartment of Medicine, CHUL Research Centre, Laval University

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Abstract

Summary

Treatment rates of osteoporosis after fracture are very low. Women who suffer a fragility fracture have a greater chance of receiving anti-fracture treatment if they had low bone mineral density (BMD), a fracture at the hip, femur or pelvis, administration of calcium and vitamin D supplements and/or an age ≥60 years.

Introduction

This investigation identifies the predictors of osteoporosis treatment 6 to 8 months following fragility fracture in women >50 years of age.

Methods

In this prospective cohort study, women were recruited 0 to 16 weeks following fracture and classified as having experienced fragility or traumatic fractures (phase 1). Six to 8 months following fracture, women completed a questionnaire on demographic features, clinical characteristics and risk factors for osteoporosis (phase 2). Osteoporosis treatment was defined as initiating anti-fracture therapy (bisphosphonate, raloxifene, nasal calcitonin and teriparatide) after fracture in those previously untreated.

Results

Of the 1,273 women completing phase 1, 1,001 (79%) sustained a fragility fracture, and of these women, 738 were untreated for osteoporosis at phase 1 and completed the phase 2 questionnaire. Significant predictors of treatment included BMD result, fracture site, administration of calcium and vitamin D supplements at the time of fracture and age ≥60 years. All other risk factors for osteoporosis, such as fracture history after the age of 40 years, family history of osteoporosis and comorbidities did not significantly influence the treatment rate.

Conclusions

Physicians largely based their decision to treat on BMD results and not on the clinical event—fragility fracture.

Keywords

Care gap Determinants Fragility fracture Osteoporosis Treatment predictors