Skip to main content

The care gap in diagnosis and treatment of women with a fragility fracture

Osteoporosis International volume 19, pages 79–86 (2008)Cite this article

Abstract

Summary

In women aged 50 years or more who experienced a fracture, 81% suffered a fragility fracture. Six to eight months after fragility fracture, 79% had either not been investigated for osteoporosis or prescribed anti-fracture therapy. Despite fragility fractures being common in this population osteoporosis is under-diagnosed and under-treated.

Introduction

The objective of this study was to evaluate the diagnostic and treatment rates for osteoporosis six months following fragility fracture.

Methods

This prospective cohort study was set in the general community from the Province of Quebec, Canada. Women at least 50 years of age who suffered a fracture were recruited during their initial visit to the hospital and had their fracture type classified as either fragility or traumatic. Six-to-eight months after fragility fracture, women were again contacted to evaluate the diagnostic and treatment rates of osteoporosis.

Results

Of the 2,075 women recruited over a 25 month period 1688 (81%) sustained a fragility fracture and 387 (19%) sustained a traumatic fracture. Nine hundred and three participants with a fragility fracture were again contacted six-to-eight months after fracture. For the 739 women not on treatment on the recruitment day, only 15.4% initiated pharmacological therapy in the six-to-eight-month period following fracture and 79.0% had either not been investigated for osteoporosis or prescribed anti-fracture treatment.

Conclusions

The proportion of fragility fractures to total fractures is higher than previously reported. Despite the availability of diagnostic modalities, effective treatments, and adequate health care assessments, there is a substantial care gap in the management of osteoporosis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Klotzbuecher CM, Ross PD, Landsman PB et al (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

    PubMed  Article  CAS  Google Scholar 

  2. Ross PD, Davis JW, Epstein RS et al (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923

    PubMed  CAS  Google Scholar 

  3. Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fracture. Can Med Assoc J 163:819–822

    CAS  Google Scholar 

  4. Ingle BM, Eastell R (2002) Site-specific bone measurements in patients with ankle fracture. Osteoporos Int 13:342–347

    PubMed  Article  CAS  Google Scholar 

  5. Jacobsen D, Sargent J, Atkinson EJ et al (1999) Contribution of weather to the seasonality of distal forearm fractures: a population-based study in Rochester, Minnesota. Osteoporos Int 9:254–259

    PubMed  Article  CAS  Google Scholar 

  6. Tromp AM, Smit JH, Deeg DJH et al (1998) Predictors for falls and fractures in longitudinal aging study Amsterdam. J Bone Miner Res 13:1932–1939

    PubMed  Article  CAS  Google Scholar 

  7. Kannus P, Palvanen M, Niemi S et al (2000) Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new Millennium. Osteoporos Int 11:443–448

    PubMed  Article  CAS  Google Scholar 

  8. Kanis JA, Oden A, Johnell O et al (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427

    PubMed  Article  CAS  Google Scholar 

  9. Khan SA, de Geus C, Holroyd B et al (2001) Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med 161:1309–1312

    PubMed  Article  CAS  Google Scholar 

  10. Kreiger N, Tenenhouse A, Joseph L et al (1999) The Canadian multicentre osteoporosis study (CaMos): background, rationale, methods. Canadian Journal of Aging 18:376–387

    Google Scholar 

  11. Iskrant AP, Smith RW (1969) Osteoporosis in women 45 years and over related to subsequent fracture. Public Health Rep 84:33–38

    PubMed  CAS  Google Scholar 

  12. Sanders KM, Pasco JA, Ugoni AM et al (1998) The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: the Geelong osteoporosis study. J Bone Miner Res 13:1337–1342

    PubMed  Article  CAS  Google Scholar 

  13. Karlsson MK, Hasserius R, Obrant KJ (1993) Individuals who sustain nonosteoporotic fractures continue to also sustain fragility fractures. Calcif Tissue Int 53:229–231

    PubMed  Article  CAS  Google Scholar 

  14. Black DM, Thompson DE, Bauer DC et al (2000) Fracture risk reduction with alendronate in women with osteoporosis: the fracture intervention trial. FIT Research Group. J Clin Endocrinol Metab 85:4118–4124

    PubMed  Article  CAS  Google Scholar 

  15. Maricic M, Adachi J, Meunier P et al (2000) Raloxifene 60 mg/day has effects within 12 months in postmenopausal osteoporosis treatment and prevention studies. Arthritis Rheum 9(suppl):S197

    Google Scholar 

  16. Harrington JT, Ste-Marie LG, Brandi ML et al (2004) Risedronate rapidly reduces the risk for nonvertebral fractures in women with postmenopausal osteoporosis. Calcif Tissue Int 74:129–135

    PubMed  Article  CAS  Google Scholar 

  17. Pols HA, Felsenberg D, Hanley DA et al (1999) Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Fosamax International Trial Study Group. Osteoporos Int 9:461–468

    PubMed  Article  CAS  Google Scholar 

  18. Roux C, Seeman E, Eastell R et al (2004) Efficacy of risedronate on clinical vertebral fractures within six months. Curr Med Res Opin 20:433–439

    PubMed  Article  CAS  Google Scholar 

  19. Brown JP Jr (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J 167:S1–S36

    Google Scholar 

  20. McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 344:333–340

    PubMed  Article  CAS  Google Scholar 

  21. Harris ST, Watts NB, Genant HK et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 282:1344–1352

    PubMed  Article  CAS  Google Scholar 

  22. Lips P (1997) Epidemiology and predictors of fractures associated with osteoporosis. Am J Med 103:S3–S8

    Article  Google Scholar 

  23. Tenenhouse A, Joseph L, Krieger N et al (2000) Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 11:897–904

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the contributions of the ROCQ programme staff, particularly programme coordinators Nathalie Migneault and Lucie Vaillancourt and administrative assistant Julie Parrot. We also acknowledge the contributions of the regional coordinators and research assistants: Sylvie Bélanger, Geneviève Corneau, Isabel Lajeunesse, Pierre-Antoine Landry, Lise Lemire, Anne-Marie Louis XVI, Julie Simard, and Lyse Roy.

Finally, we thank the regional directors, Pierre Dagenais, Kim Latendresse, Pierre Major, Frédéric Morin, Suzanne Morin, and Josée Villeneuve, for their support during the implementation of the programme and their ciritical scientific advice. We also thank past members of the ROCQ executive, Louise Lafortune, Christine Chin, Luc Sauriol, and Andy McClenaghan, for their insightful guidance.

The Recognizing Osteoporosis and its Consequences in Quebec (ROCQ) Programme is funded by Merck Frosst Canada, Inc., Procter and Gamble Pharmaceuticals, sanofi-aventis group, Eli Lilly Canada, Inc., and Novartis Pharmaceuticals Canada, Inc.

Author information

Affiliations

  1. Laval University, Rheumatology and Immunology Research Centre, CHUL Research Centre, Québec, QC, Canada

    L. Bessette, K. S. Davison & J. P. Brown

  2. University of Montreal, Department of Medicine, Centre de recherche du CHUM, Hôpital Saint-Luc, Montréal, Canada

    L.-G. Ste-Marie

  3. Institut national de santé publique du Québec, Québec, QC, Canada

    S. Jean

  4. Patient Health Management, Merck Frosst Canada Ltd, Montréal, QC, Canada

    M. Beaulieu

  5. Sanofi-aventis Canada Inc, Laval, QC, Canada

    M. Baranci

  6. P&G Pharmaceuticals Canada Inc, Toronto, ON, Canada

    J. Bessant

  7. 2705, boulevard Laurier, Room S-784, Quebec, QC, GIV 4G2, Canada

    L. Bessette

Authors
  1. L. Bessette
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L.-G. Ste-Marie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Jean
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. S. Davison
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Beaulieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Baranci
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Bessant
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. P. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Bessette.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bessette, L., Ste-Marie, LG., Jean, S. et al. The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 19, 79–86 (2008). https://doi.org/10.1007/s00198-007-0426-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-007-0426-9

Keywords

  • Care gap
  • Diagnosis
  • Fragility fracture
  • Osteoporosis
  • Treatment