The osteoporosis care gap in Canada.
BACKGROUND
The presence of a fragility fracture is a major risk factor for osteoporosis, and should be an indicator for osteoporosis diagnosis and therapy. However, the extent to which patients who fracture are assessed and treated for osteoporosis is not clear.


METHODS
We performed a review of the literature to identify the practice patterns in the diagnosis and treatment of osteoporosis in adults over the age of 40 who experience a fragility fracture in Canada. Searches were performed in MEDLINE (1966 to January 2, 2003) and CINAHL (1982 to February 1, 2003) databases.


RESULTS
There is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. The proportion of individuals with a fragility fracture who received an osteoporosis diagnostic test or physician diagnosis ranged from 1.7% to 50%. Therapies such as hormone replacement therapy, bisphosphonates or calcitonin were being prescribed to 5.2% to 37.5% of patients. Calcium and vitamin D supplement intake was variable, and ranged between 2.8% to 61.6% of patients.


CONCLUSIONS
Many Canadians who experience fragility fracture are not receiving osteoporosis management for the prevention of future fractures.
Papaioannou
A
A
Department of Medicine, McMaster University, Hamilton, Canada. papaioannou@hhsc.ca
Giangregorio
L
L
Kvern
B
B
Boulos
P
P
Ioannidis
G
G
Adachi
J D
JD
D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002116:Calcitonin / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D004164:Diphosphonates / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data; D015914:Estrogen Replacement Therapy; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012008:Recurrence; D014807:Vitamin D / Q000627:therapeutic use
D004164:Diphosphonates; D014807:Vitamin D; D002116:Calcitonin; D002118:Calcium