The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study
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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.
KeywordsBisphosphonate 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.
- 1.National Osteoporosis Foundation (2002) America’s bone health: the state of osteoporosis and bone health. National Osteoporosis Foundation, Washington, DC. USAGoogle Scholar
- 13.Papaioannou A, Wiktorowicz M, Adachi JD et al (2000) Mortality, independence in living, and re-fracture, one year following hip fractures in Canadians. J Obstet Gynaecol Can 22:591–597Google Scholar
- 17.National Osteoporosis Foundation [homepage on the Internet] Washington, DC. USA. National Osteoporosis Foundation, c2003 [cited June 2006]. Physician’s Guide to Prevention and Treatment of Osteoporosis; [about 1 screen]. Available from: http://noforg/physguide/
- 18.(1996) Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada. CMAJ 155:1113–1133Google Scholar
- 25.Kreiger N, Tenenhouse A, Joseph L et al (2002) The Canadian Multicenter Osteoporosis Study (CaMos): background, rationale, methods. Can J Aging 18:376–387Google Scholar
- 34.Papaioannou A, Coker E, Kennedy CK et al (2004) A multi-faceted post fracture care model: the fracture? Think osteoporosis! Program. J Bone Miner Res 19:S318Google Scholar