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


BACKGROUND
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 1,688 (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.
Bessette
L
L
Laval University, Rheumatology and Immunology Research Centre, CHUL Research Centre, Québec, QC, Canada. rocq@crchul.ulaval.ca
Ste-Marie
L-G
LG
Jean
S
S
Davison
K S
KS
Beaulieu
M
M
Baranci
M
M
Bessant
J
J
Brown
J P
JP
D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D017050:Episode of Care; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005598:Fractures, Spontaneous / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology