Skip to main content


Log in

Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript


The objectives of this study were to determine information needs of family physicians around issues in the management of osteoporosis and preferences for dissemination of this information. A mailed survey was sent to a stratified random sample of 1000 family physicians in Ontario in May 2001. Female physicians and those practicing in rural communities were over-sampled from the College of Family Physicians' database. Among the 505 respondents, 364 were still practicing (182 males and 182 females) and completed the full questionnaire. There were no statistically significant differences in responses by sex or region of practice. Over 80% of family physicians wanted to be more informed about bone density testing and the pharmacological and non-pharmacological management of osteoporosis. The presence of risk factors was one of the most influential factors (72%) for ordering bone density testing. Information in peer-reviewed journals was thought to be the most credible, with 80% rating the CMAJ as very credible compared to 47% for the Osteoporosis Society of Canada (OSC). Sixty-two percent found the OSC guidelines (1996) to be useful even though much of that information is now out of date. Almost 70% had not read the more recently published treatment guidelines from the Ontario Program for Optimal Therapeutics (2000). Over 80% were interested in a decision aid, which incorporates information on risk factors, fracture risk and a treatment algorithm. The perceived need and the lack of availability of clinically useful information on osteoporosis for the family practice setting highlights the failure of the current guideline implementation process and provides insight into where the process has to be improved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Goeree R, O'Brien B, Pettitt D, Cuddy L, Ferraz M, Adachi J (1996) An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can 18:15–24

    Google Scholar 

  2. Jaglal SB, McIsaac WJ, Hawker G, Jaakkimainen L, Cadarette SM, Chan BT (2000) Patterns of use of the bone mineral density test in Ontario, 1992–1998. CMAJ 163:1139–1143

    CAS  PubMed  Google Scholar 

  3. Jaglal SB (2002) Bone density testing. In: Stewart DE, Ferris L, Hyman I, Cohen M, Williams JI, Cheung A (eds) Ontario Women's Health Status Report 113–120

  4. Freemantle N, Harvey EL, Wolf E, Grimshaw JM, Grilli R, Bero LA (2000) Printed educational materials: effects on professional practice and health care outcomes (Cochrane Review). Cochrane Database Syst Rev 2:CD000172

    PubMed  Google Scholar 

  5. Davis DA, Taylor-Vaisey A (1997) Translating guidelines into practice. CMAJ 157:408–416

    CAS  PubMed  Google Scholar 

  6. Jaglal S, Hawker G, Carroll J, McIsaac W, Jaakkimainen L, Cadarette S, Davis D (2003) How are family physicians managing osteoporosis? Canadian Family Physician 49:462–468

  7. Cadarette S, Jaglal S, Kreiger N, McIsaac W, Darlington G, Tu JV (2000) Development and validation of the osteoporosis risk assessment instrument to select women for bone densitometry. CMAJ 169:1289–1294

    Google Scholar 

  8. Osteoporosis Society of Canada, Scientific Advisory Board (1996) Clinical practice guidelines for the diagnosis and management of osteoporosis. CMAJ 155:1113–1133

    PubMed  Google Scholar 

  9. Society of Obstetricians and Gynaecologists of Canada (2001) Canadian Consensus on Menopause and Osteoporosis. J Obstet Gynaecol Can 23:967–988

    Google Scholar 

  10. Anonymous (2000) Ontario guidelines for the prevention and treatment of osteoporosis. Ontario Program for Optimal Therapeutics of the Ontario Ministry of Health and Long-Term Care,

  11. Taylor JC, Sterkel B, Utley M, Shipley M, Newman S, Horton M and Fitz-Clarence H (2001) Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management. Osteoporos Int 12:844–848

    Article  CAS  PubMed  Google Scholar 

  12. Society of Obstetricians and Gynaecologists of Canada (1998) Canadian Consensus on Menopause and Osteoporosis. J Obstet Gynaecol Can 20:1264–1272

    Google Scholar 

  13. Anonymous (1997) The prevention and management of osteoporosis. Consensus statement. Australian National Consensus Conference 1996. Med J Aust 167:1–15

    Google Scholar 

  14. National Osteoporosis Foundation (1998) Physician's guide to prevention and treatment of osteoporosis. Excerpta Medica, Belle Mead, New Jersey, p 29

  15. Hajscar EE, Hawker G, Bogoch E (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163:819–822

    PubMed  Google Scholar 

  16. Khan SA, DeGeus C, Holroyd B, Russell AS (2001) Osteoporosis follow-up after wrist fractures following minor trauma. Arch Int Med 161:1309–1312

    Article  CAS  Google Scholar 

  17. Juby AG, DeGues-Wenceslau CM (2002) Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int 13:205–210

    Article  Google Scholar 

  18. Hodsman AB, Hanley DA, Josse R (2002) Do bisphosphonates reduce the risk of osteoporotic fractures? An evaluation of evidence to date. CMAJ 166:1426–1430

    PubMed  Google Scholar 

  19. Klotzbuecher CM, Ross PD, Landsman PB, Abbott III TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739

    CAS  PubMed  Google Scholar 

  20. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J (1999) Potential benefits, limitations, and harms of clinical guidelines. BMJ 318:527–530

    CAS  PubMed  Google Scholar 

  21. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA (1998) Closing the gap between research and practice: an overview of systematic reviews of interventions to promote implementation of research findings. BMJ 317:465–468

    CAS  PubMed  Google Scholar 

  22. Thomson R, Lavender M, Madhok R (1995) How to ensure guidelines are effective. BMJ 311:237–241

    CAS  PubMed  Google Scholar 

Download references


We would like to express our gratitude to the physicians who participated in the study. This study was funded by a grant from the Ontario Program for Optimal Therapeutics. Dr. Jaglal is a Career Scientist of the Ontario Ministry of Health and Long-Term Care. Dr. Hawker is a Canadian Institutes of Health Research Scientist. Suzanne Cadarette is supported by a doctoral research award from the Canadian Institutes of Health Research in partnership with the Ontario Ministry of Health and Long-Term Care. Dr. Carroll is the Sydney G. Frankfort Chair in Family Medicine at the University of Toronto.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Susan B. Jaglal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jaglal, S.B., McIsaac, W.J., Hawker, G. et al. Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporos Int 14, 672–676 (2003).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: