Osteoporosis International

, Volume 19, Issue 4, pp 581–587 | Cite as

The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study

  • A. Papaioannou
  • C. C. Kennedy
  • G. Ioannidis
  • Y. Gao
  • A. M. Sawka
  • D. Goltzman
  • A. Tenenhouse
  • L. Pickard
  • W. P. Olszynski
  • K. S. Davison
  • S. Kaiser
  • R. G. Josse
  • N. Kreiger
  • D. A. Hanley
  • J. C. Prior
  • J. P. Brown
  • T. Anastassiades
  • J. D. Adachi
  • CaMos Research Group
Original Article



We examined osteoporosis diagnosis/treatment in 2,187 community dwelling men age 50+. After five years in the study, 90% of men with fragility fractures remained undiagnosed and untreated for osteoporosis. The need to treat fragility fractures is well established in guidelines, and these numbers represent an important care gap.


Whether physicians in the community are recognizing and appropriately treating osteoporosis and fragility fractures in men remains unknown. We examined the rate of diagnosis and treatment in community dwelling men participating in the Canadian Multicentre Osteoporosis Study (CaMos).


Between February 1996 and September 2002, 2,187 participants were recruited from nine sites across Canada and prospectively followed. Information on osteoporosis diagnosis, fractures, medications were collected annually by a detailed questionnaire. DXA examination of lumbar spine (L1-4) and hip were conducted at baseline and year five.


Diagnosis and treatment in men with clinical fragility fractures was low: at baseline and year five only 2.3% and 10.3% of men with a clinical fracture reported an osteoporosis diagnosis, respectively. At year five, 90% of men with a clinical fragility fracture were untreated. Hip fractures were the most commonly treated (37.5% by year five). A diagnosis of osteoporosis resulted in greater treatment: 67% of participants with diagnosed osteoporosis were treated with a bisphosphonate and 87% were taking calcium and/or vitamin D (year five).


In this population-based study, both a diagnostic and therapeutic gap existed between knowledge and practice related to fragility fractures and osteoporosis in men aged ≥50 years.


Bisphosphonate Care gap Diagnosis Fractures Males Osteoporosis 



The Canadian Multicentre Osteoporosis Study was funded by the Canadian Institutes of Health Research (CIHR), Merck Frosst Canada Ltd., Eli Lilly Canada Inc., Novartis Pharmaceuticals Inc., The Alliance: sanofi-aventis & Procter and Gamble Pharmaceuticals Canada Inc., The Dairy Farmers of Canada, The Arthritis Society. The authors wish to acknowledge the CaMos Research Group, for its role in implementing and overseeing the project. We thank Claudie Berger and Wei Zhou for data analysis and manuscript review, and Janet Pritchard for her assistance with editing and submitting the manuscript.

Role of the sponsor

The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  • A. Papaioannou
    • 1
  • C. C. Kennedy
    • 1
  • G. Ioannidis
    • 1
  • Y. Gao
    • 2
  • A. M. Sawka
    • 3
  • D. Goltzman
    • 4
  • A. Tenenhouse
    • 4
  • L. Pickard
    • 1
  • W. P. Olszynski
    • 5
  • K. S. Davison
    • 6
  • S. Kaiser
    • 7
  • R. G. Josse
    • 3
  • N. Kreiger
    • 3
  • D. A. Hanley
    • 8
  • J. C. Prior
    • 9
  • J. P. Brown
    • 6
  • T. Anastassiades
    • 10
  • J. D. Adachi
    • 1
  • CaMos Research Group
  1. 1.Division of Geriatric MedicineMcMaster UniversityHamiltonCanada
  2. 2.CaMos Analysis CentreMcGill UniversityMontrealCanada
  3. 3.University of TorontoTorontoCanada
  4. 4.McGill UniversityMontrealCanada
  5. 5.University of SaskatchewanSaskatoonCanada
  6. 6.Laval UniversitySte-FoyCanada
  7. 7.Dalhousie UniversityHalifaxCanada
  8. 8.University of CalgaryCalgaryCanada
  9. 9.University of British ColumbiaVancouverCanada
  10. 10.Queen’s UniversityKingstonCanada

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