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Osteoporosis treatment gap in patients at risk of fracture in Egypt: a multi-center, cross-sectional observational study

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Abstract

Summary

Despite the wide availability of a wide variety of approved osteoporosis medications and DXA scan centers in Egypt, only a minority of patients at high risk of sustaining a fragility fracture receive treatment, even after their first fracture. Such big “treatment gap” leaves the most high-risk individuals unprotected against fragility fractures. This study provides a benchmark to monitor national trends in osteoporosis management and service uptake.

Purpose

To assess the treatment gap among men and postmenopausal women presenting with a fragility fracture, and to analyze the characteristics and fracture risks of the patients presenting with an index fragility fracture.

Methods

This was a multi-center, cross-sectional, observational study. Both men and postmenopausal women, admitted with an osteoporotic fracture (whether major osteoporosis or hip fracture), were consecutively recruited for this work. The fracture risk was assessed based on their FRAX calculation prior to the index fracture. All the patients were assessed for their falls and sarcopenia risks. Blood tests for bone profile as well as DXA scan were offered to all the patients.

Results

Two hundred and thirty-six patients presenting with fragility fractures were included in this work. 70.8% were women and 29.2% were men. Mean age was 70.1 (SD = 9.2) years. Ten-year probability of fracture (without BMD) was high in 65.9% of the postmenopausal women and 40.3% of the men. 82.1% of the postmenopausal women and 100% in men identified to be eligible for osteoporosis therapy did not receive any form of osteoporosis therapy. FRAX score correlated significantly with bone mineral density assessment at both hip and spine. Falls, sarcopenia, and functional disability showed significant relation to the fracture risk.

Conclusions

There is a large treatment gap in Egyptian older adults. The recent guidelines for osteoporosis management in Egypt endorsed fracture centric approach to identify people at risk. The gap appears to be related to a low rate of osteoporosis diagnosis and lack of patient education.

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Authors and Affiliations

  1. Institute of Medical Sciences, Canterbury Christ Church University, Canterbury, England

    Yasser El Miedany

  2. Community and Public Health, Ain Shams University, Cairo, Egypt

    Maha El Gaafary

  3. Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt

    Naglaa Gadallah

  4. Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt

    Safaa Mahran & Nihal Fathi

  5. Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt

    Mohamed Hassan Abu Zaid & Samar Abdel Hamid Tabra

  6. Rheumatology and Rehabilitation, Benha University, Benha, Egypt

    Waleed Hassan

  7. Rheumatology, Physcial Medicine and Rehabilitation, Alexandria University, Alexandria, Egypt

    Walaa Elwakil

Authors
  1. Yasser El Miedany
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  2. Maha El Gaafary
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  3. Naglaa Gadallah
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  4. Safaa Mahran
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  5. Nihal Fathi
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  6. Mohamed Hassan Abu Zaid
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  7. Samar Abdel Hamid Tabra
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  8. Waleed Hassan
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  9. Walaa Elwakil
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Correspondence to Yasser El Miedany.

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El Miedany, Y., El Gaafary, M., Gadallah, N. et al. Osteoporosis treatment gap in patients at risk of fracture in Egypt: a multi-center, cross-sectional observational study. Arch Osteoporos 18, 58 (2023). https://doi.org/10.1007/s11657-023-01252-8

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  • DOI: https://doi.org/10.1007/s11657-023-01252-8

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