Osteoporosis International

, Volume 20, Issue 3, pp 491–496 | Cite as

Management of osteoporosis in primary care in Australia

  • J. S. Chen
  • C. Hogan
  • G. Lyubomirsky
  • P. N. Sambrook
Short Scientific Communication

Abstract

Summary

This study reviewed factors influencing osteoporosis management in primary care settings in Australia and examined risk profiles of patients (n = 37,957) for osteoporosis. Only 29.7% of patients with a prior fracture were currently on specific medication for osteoporosis. The results highlight the need for further exploration of barriers to osteoporosis management.

Introduction

Osteoporosis management in primary care is suboptimal even for high-risk people with a history of prior fracture.

Methods

This study reviewed factors influencing the management of individuals at risk for osteoporosis in primary care settings in Australia and examined risk profiles of patients for osteoporosis. Patients (n = 37,957, mean age 71) were recruited over a 12-month period (February 2006–Jan 2007) and interviewed.

Results

With regard to risk factors for osteoporosis, 12.6% of patients reported a history of prior minimal trauma fracture, 7.5% reported a family history of osteoporosis, 7.4% reported they were current smokers, 11.4% reported low dietary calcium intake, 31.8% reported no regular weekly physical exercise and 10.3% reported current use of glucocorticoids. Of those with a prior fracture, only 29.7% were currently on specific medication for osteoporosis. Radiography (n = 17,754) demonstrated a prior vertebral fracture in 30.1%, but only 3.8% of the 17,754 patients reported current use of specific osteoporosis medication.

Conclusions

This study has confirmed low rates of treatment in primary care even in individuals who have already suffered a prior fracture or have other risk factors. This study highlights the need for further exploration of barriers to osteoporosis management in the primary care setting.

Keywords

Fracture Osteoporosis management Primary care 

References

  1. 1.
    Sambrook P, Seeman E, Phillips S, Ebeling P (2002) Preventing osteoporosis—outcomes of the Australian Fracture Prevention Summit. Med J Aust 176(Suppl):S1–S16PubMedGoogle Scholar
  2. 2.
    Osteoporosis Australia (2007) The burden of brittle bones: epidemiology, costs and burden of osteoporosis in Australia. (http://www.arthritisvic.org.au/downloads/Burden%20of%20brittle%20bones.pdf)
  3. 3.
    Norton R, Campbell AJ, Lee-Joe T et al (1997) Circumstances of, falls resulting in hip fractures among older people. J Am Geriatr Soc 45(9):1108–1112PubMedGoogle Scholar
  4. 4.
    Sanders KM, Nicholson GC, Ugoni AM et al (1999) Health burden of hip and other fractures in Australia beyond 2000. Projections based on the Geelong Osteoporosis Study. Med J Aust 170:467–470PubMedGoogle Scholar
  5. 5.
    World Health Organization (2007) Assessment of osteoporosis at the primary health care level. Geneva: WHO. (http://www.who.int/chp/topics/rheumatic/en/index.html)
  6. 6.
    Kanis JA, Johnell O, Oden A et al (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRefGoogle Scholar
  7. 7.
    Ross PD, Davis JW, Epstein RS et al (1991) Pre-existing fractures and bone mass predict vertebral fracture in women. Ann Int Med 114:919–923PubMedGoogle Scholar
  8. 8.
    Cummings SR, Nevitt MC, Browner WS et al (1995) Risk factors for hip fractures in white women. N Engl J Med 332:767–773PubMedCrossRefGoogle Scholar
  9. 9.
    Robinson CM, Royds M, Abraham A et al (2002) Refractures in patients at least 45 years old. J Bone Jt Surg 84:1528–1533CrossRefGoogle Scholar
  10. 10.
    Gunnes M, Mellstrom D, Johnell O (1998) How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal women. Acta Orthop Scand 69(5):508–512PubMedCrossRefGoogle Scholar
  11. 11.
    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(4):721–739PubMedCrossRefGoogle Scholar
  12. 12.
    Zochling JM, Schwarz JM, March L et al (2001) Is osteoporosis undertreated after minimal trauma fracture? Med J Aust 174:663–664PubMedGoogle Scholar
  13. 13.
    Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163:819–822PubMedGoogle Scholar
  14. 14.
    Kamel HK, Hussain MS, Tariq S et al (2000) Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 109:326–328PubMedCrossRefGoogle Scholar
  15. 15.
    Al-Allaf AW, Pal B, Reid N (1998) An audit of post fracture rehabilitation with special emphasis on osteoporosis assessment and treatment. Clin Exp Rheum 16:451–453Google Scholar
  16. 16.
    Freedman KB, Kaplan FS, Bilker WB et al (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82:1063–1070PubMedGoogle Scholar
  17. 17.
    Torgerson DJ, Dolan P (1998) Prescribing by general practitioners after an osteoporotic fracture. Ann Rheum Dis 57:378–379PubMedCrossRefGoogle Scholar
  18. 18.
    Eisman J, Clapham S, Kehoe L (2004) Osteoporosis prevalence and levels of treatment in primary care: the Australian BoneCare Study. J Bone Miner Res 19:1969–1975PubMedCrossRefGoogle Scholar
  19. 19.
    Solomon DH, Polinski JM, Stedman M et al (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22:362–367PubMedCrossRefGoogle Scholar
  20. 20.
    Majumdar SR, Johnson JA, McAlister FA et al (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ 178:569–575PubMedGoogle Scholar
  21. 21.
    Taylor JC, Sterkel B, Utley M et al (2001) Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management. Osteoporos Int 12:844–848PubMedCrossRefGoogle Scholar
  22. 22.
    Jaglal SB, Carroll J, Hawker G et al (2003) How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician 49:462–468PubMedGoogle Scholar
  23. 23.
    Kamalakanthan, Abhaya and Jackson, Sukhan (2006) The supply of doctors in Australia: Is there A shortage? Discussion paper No. 341, School of Economics, The University of Queensland. (http://eprint.uq.edu.au/archive/00004125/01/econ_dp_341_06.pdf)

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • J. S. Chen
    • 1
  • C. Hogan
    • 2
  • G. Lyubomirsky
    • 3
  • P. N. Sambrook
    • 4
    • 5
  1. 1.Institute of Bone & Joint ResearchRoyal North Shore HospitalSydneyAustralia
  2. 2.SunburyAustralia
  3. 3.Merck, Sharpe and Dohme AustraliaGranville, SydneyAustralia
  4. 4.Kolling InstituteUniversity of SydneySydneyAustralia
  5. 5.Royal North Shore Hospital, St LeonardsSydneyAustralia

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