The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study.
We examined osteoporosis diagnosis/treatment in 2,187 community dwelling men age 50+. After five years in the study, 90% of men with fragility fractures remained undiagnosed and untreated for osteoporosis. The need to treat fragility fractures is well established in guidelines, and these numbers represent an important care gap.


BACKGROUND
Whether physicians in the community are recognizing and appropriately treating osteoporosis and fragility fractures in men remains unknown. We examined the rate of diagnosis and treatment in community dwelling men participating in the Canadian Multicentre Osteoporosis Study (CaMos).


METHODS
Between February 1996 and September 2002, 2,187 participants were recruited from nine sites across Canada and prospectively followed. Information on osteoporosis diagnosis, fractures, medications were collected annually by a detailed questionnaire. DXA examination of lumbar spine (L1-4) and hip were conducted at baseline and year five.


RESULTS
Diagnosis and treatment in men with clinical fragility fractures was low: at baseline and year five only 2.3% and 10.3% of men with a clinical fracture reported an osteoporosis diagnosis, respectively. At year five, 90% of men with a clinical fragility fracture were untreated. Hip fractures were the most commonly treated (37.5% by year five). A diagnosis of osteoporosis resulted in greater treatment: 67% of participants with diagnosed osteoporosis were treated with a bisphosphonate and 87% were taking calcium and/or vitamin D (year five).


CONCLUSIONS
In this population-based study, both a diagnostic and therapeutic gap existed between knowledge and practice related to fragility fractures and osteoporosis in men aged >or=50 years.
Papaioannou
A
A
Division of Geriatric Medicine, McMaster University, Hamilton Health Sciences-Chedoke Site, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada. papaioannou@hhsc.ca
Kennedy
C C
CC
Ioannidis
G
G
Gao
Y
Y
Sawka
A M
AM
Goltzman
D
D
Tenenhouse
A
A
Pickard
L
L
Olszynski
W P
WP
Davison
K S
KS
Kaiser
S
S
Josse
R G
RG
Kreiger
N
N
Hanley
D A
DA
Prior
J C
JC
Brown
J P
JP
Anastassiades
T
T
Adachi
J D
JD
D001294:Attitude to Health; D015519:Bone Density / Q000502:physiology*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002170:Canada; D003695:Delivery of Health Care / Q000592:standards; D004164:Diphosphonates / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014807:Vitamin D / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D014807:Vitamin D