Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study
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Canadian women over 50 years old were studied over a 10-year period to see if those who sustained a fracture (caused by minimal trauma) were receiving the recommended osteoporosis therapy. We found that approximately half of these women were not being treated, indicating a significant care gap in osteoporosis treatment.
Prevalent fragility fracture strongly predicts future fracture. Previous studies have indicated that women with fragility fractures are not receiving the indicated treatment. We aimed to describe post fracture care in Canadian women using a large, population-based prospective cohort that began in 1995–1997.
We followed 5,566 women over 50 years of age from across Canada over a period of 10 years in the Canadian Multicentre Osteoporosis Study. Information on medication use and incident clinical fragility fractures was obtained during a yearly questionnaire or interview and fractures were confirmed by radiographic/medical reports.
Over the 10-year study period, 42–56% of women with yearly incident clinical fragility fractures were not treated with an osteoporosis medication. During year 1 of the study, 22% of the women who had experienced a fragility fracture were on treatment with a bisphosphonate and 26% were on hormone therapy (HT). We were not able to differentiate HT use for menopause symptoms vs osteoporosis. Use of bisphosphonate therapy increased over time; odds ratio (OR) for use at year 10 compared to use at year 1 was 3.65 (95% confidence interval (CI) 1.83–7.26). In contrast, HT use declined, with an OR of 0.07 (95%CI 0.02–0.24) at year 10 compared to year 1 of the study.
In a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures. Although bisphosphonate therapy usage improved over time, a substantial gap remains.
KeywordsBisphosphonates Care gap Fragility fracture Osteoporosis Postmenopausal women
The authors thank all the participants in the CaMos study, who's participation made this research possible. The CaMos Research Group: David Goltzman (co-principal investigator, McGill University), Nancy Kreiger (co-principal investigator, Toronto), Alan Tenenhouse (principal investigator emeritus, Toronto). CaMos Coordinating Centre, McGill University, Montreal, Quebec:Suzette Poliquin (national coordinator), Suzanne Godmaire (research assistant), Silvia Dumont (administrative assistant), Claudie Berger (study statistician), Wei Zhou (statistician). Memorial University, St. John’s Newfoundland: Carol Joyce (director), Christopher Kovacs (co-director), Emma Sheppard (coordinator). Dalhousie University, Halifax, Nova Scotia: Susan Kirkland, Stephanie Kaiser (co-directors), Barbara Stanfield (coordinator). Laval University, Quebec City, Quebec: Jacques P. Brown (director), Louis Bessette (co-director), Marc Gendreau (coordinator). Queen’s University, Kingston, Ontario: Tassos Anastassiades (director), Tanveer Towheed (co-director), Barbara Matthews (coordinator). University of Toronto, Toronto, Ontario: Bob Josse (director), Sophie Jamal (co-director), Tim Murray (past director), Barbara Gardner-Bray (coordinator). McMaster University, Hamilton, Ontario: Jonathan D. Adachi (director), Alexandra Papaioannou (co-director), Laura Pickard (coordinator). University of Saskatchewan, Saskatoon, Saskatchewan: Wojciech P. Olszynski (director), K. Shawn Davison (co-director), Jola Thingvold (coordinator). University of Calgary, Calgary, Alberta: David A. Hanley (director), Jane Allan (coordinator).University British Columbia, Vancouver, British Columbia: Jerilynn C. Prior (director), Millan Patel (co-director), Yvette Vigna (coordinator), Brian Lentle (radiologist).
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.; Servier Canada Inc.; Amgen Canada Inc.; The Dairy Farmers of Canada; and The Arthritis Society.
This work was supported by the Osteoporosis Canada and CaMos joint Fellowship Research Award, www.osteoporosis.ca. Dr. Fraser was also supported by the University of Western Ontario Resident Research Career Development Program.
Conflicts of interest
Dr. Fraser, Dr. Ioannidis, Ms. Pickard, Dr. Prior, Dr. Olszynski, Dr. Anastassiades, Dr. Jamal, Dr. Josse, and Dr. Goltzman have no conflicts of interest to declare for this manuscript.
Dr. Adachi has been a consultant/speaker for: Amgen, Astra Zeneca, Eli Lilly, GSK, Merck, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, Sanofi Aventis, Servier, Wyeth and Bristol-Myers Squibb; and has conducted clinical trials for: Amgen, Eli Lilly, GSK, Merck, Novartis, Pfizer, Procter & Gamble, Sanofi Aventis, Roche, Wyeth, and Bristol-Myers Squibb.
Dr. Kaiser has been on the advisory board for: Amgen, Novartis, Eli Lilly, Bristol-Myers Squibb, and Astra Zeneca; and speakers bureau for: Amgen, Novartis, Procter & Gamble/Sanofi Aventis, Merck Frosst, and Eli Lilly.
Dr. Jacques Brown has received consulting fees or other remuneration from: Abbott, Amgen, Eli Lilly, Novartis, Merck, and Warner Chilcott; received research grants from: Abbott, Amgen, Bristol-Myers-Squibb, Eli Lilly, Pfizer, and Roche; and been on the speakers bureau for: Eli Lilly, Amgen, Novartis, Merck, and Warner Chilcott.
Dr. Hanley has been on the advisory board for: Amgen, Merck Frosst, Warner-Chilcott, Novartis, and Eli Lilly; performed clinical trials for: Amgen, Merck Frosst, Procter & Gamble/Sanofi Aventis, Novartis, NPS Pharmaceuticals, Eli Lilly, Pfizer, and Wyeth-Ayerst; and received speaking honoraria from: Amgen, Merck Frosst, Procter & Gamble/Sanofi Aventis, Novartis, NPS Pharmaceuticals, Eli Lilly, Pfizer, and Wyeth-Ayerst.
Dr. Papaioannou has been a consultant/speaker for: Amgen, Aventis, Eli Lilly, Merck Frosst, Novartis, Procter & Gamble, Servier, and Wyeth-Ayerst; conducted clinical trials for: Eli Lilly, Merck Frosst, Novartis, Procter & Gamble, and Sanofi-Aventis; and received unrestricted grants from: Amgen, Eli Lilly, Merck Frosst, Procter & Gamble, and Sanofi-Aventis.
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