title: Postfracture care for older women: gaps between optimal care and actual care.
abstract: OBJECTIVE
  To investigate rates of assessment and treatment of osteoporosis among older women during the year after they have had fractures.
  
  
  METHODS
  Observational, historical, population-based cohort study.
  
  
  METHODS
  Manitoba, which maintains a comprehensive population-based repository of health care services provided and has a publicly funded health care system.
  
  
  METHODS
  Women 50 years old and older who had suffered fractures between 1997 and 2002. These women were chosen from among approximately 175,000 women of this age in Manitoba.
  
  
  METHODS
  We examined each woman's annual medical record between April 1, 1997, and March 31, 2002, to find any International Classification of Diseases fracture codes that have been consistently associated with osteoporosis. We looked for postfracture care during the first 12 months after fractures: bone mineral density (BMD) testing or treated with osteoporosis pharmacotherapy. Analysis was stratified by type of fracture: designated type 1 fractures (spine or hip) and type 2 fractures (not spine or hip).
  
  
  METHODS
  Use of BMD testing or osteoporosis pharmacotherapy during the first 12 months following fractures.
  
  
  RESULTS
  For type 1 fractures, BMD assessment during the first year after fracture increased from 2.6% in 1997-1998 to 4.6% in 2001-2002 (P for trend .0004). Rates of therapy with osteoporosis medication increased from 4.9% in 1997-1998 to 17.6% in 2001-2002 (P for trend < .0001). Results were similar for type 2 fractures. In the final year of the study, only 20.5% of women with either type of fracture underwent any identifiable intervention (BMD assessment or osteoporosis pharmacotherapy). The intervention rate was substantially higher among women 50 to 64 years old (26.4%) than among those 75 years old or older (17.9%, P for trend < .0001).
  
  
  CONCLUSIONS
  Women at highest risk of future fractures are assessed infrequently for osteoporosis with BMD testing and given pharmacotherapy to prevent future fractures just as infrequently. This gap in care was particularly striking for BMD testing despite the fact that testing is free in Manitoba's publicly funded system. Data from this study could be educational for physicians treating osteoporosis and should encourage them to improve their practice patterns and optimize patient care.
authors.affiliation: Faculty of Pharmacy at Manitoba Centre for Health Policy in Department of Community Health Sciences in Faculty of Medicine at University of Manitoba in Winnipeg. c_metge@umanitoba.ca
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Metge
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.forename: Lori-Jean
authors.initials: LJ
authors.lastname: Manness
authors.forename: Marina
authors.initials: M
authors.lastname: Yogendran
authors.forename: C K
authors.initials: CK
authors.lastname: Yuen
authors.forename: Brent
authors.initials: B
authors.lastname: Kvern
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D015897:Comorbidity; D011756:Diphosphates / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D005791:Patient Care / Q000592:standards* / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000706:statistics & numerical data; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D011756:Diphosphates; D020845:Selective Estrogen Receptor Modulators
references.citation: MMWR Recomm Rep. 2004 Sep 10;53(RR-11):1-6
references.pmid: 15359215
references.citation: N Engl J Med. 1997 Oct 30;337(18):1279-84
references.pmid: 9345078
references.citation: J Clin Densitom. 2003 Fall;6(3):275-82
references.pmid: 14514998
references.citation: JAMA. 2002 Jul 17;288(3):321-33
references.pmid: 12117397
references.citation: Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78
references.pmid: 11816692
references.citation: AJR Am J Roentgenol. 2004 Feb;182(2):297-300
references.pmid: 14736649
references.citation: Osteoporos Int. 2004 Oct;15(10):767-78
references.pmid: 15258724
references.citation: Curr Med Res Opin. 2004 Apr;20(4):433-9
references.pmid: 15119979
references.citation: Bone. 2004 Aug;35(2):375-82
references.pmid: 15268886
references.citation: J Bone Miner Res. 2000 Feb;15(2):322-31
references.pmid: 10703935
references.citation: J Am Geriatr Soc. 2006 Mar;54(3):485-9
references.pmid: 16551317
references.citation: Med Care. 1999 Jun;37(6 Suppl):JS42-59
references.pmid: 10409017
references.citation: Am J Med. 2003 Oct 1;115(5):398-400
references.pmid: 14553876
references.citation: Arch Intern Med. 2003 Sep 22;163(17):2052-7
references.pmid: 14504118
references.citation: Osteoporos Int. 2005 Feb;16(2):208-15
references.pmid: 15517185
references.citation: Med Care. 1996 Jun;34(6):570-82
references.pmid: 8656723
references.citation: BMJ. 2006 Mar 11;332(7541):571-4
references.pmid: 16513687
references.citation: BMJ. 2005 Mar 19;330(7492):609-10
references.pmid: 15774963
references.citation: J Bone Miner Res. 2006 May;21(5):765-71
references.pmid: 16734392
references.citation: JAMA. 2001 Dec 12;286(22):2866-8
references.pmid: 11735764
references.citation: Inj Prev. 2002 Dec;8(4):280-3
references.pmid: 12460962
references.citation: Osteoporos Int. 2008 Apr;19(4):581-7
references.pmid: 17924051
references.citation: Osteoporos Int. 1995;5(6):427-32
references.pmid: 8695963
references.citation: Am J Clin Nutr. 2000 Sep;72(3):745-50
references.pmid: 10966893
references.citation: Endocr Rev. 2002 Aug;23(4):570-8
references.pmid: 12202472
references.citation: Arch Intern Med. 1989 Nov;149(11):2445-8
references.pmid: 2818106
references.citation: CMAJ. 2000 Oct 3;163(7):819-22
references.pmid: 11033708
references.citation: CMAJ. 2004 Oct 12;171(8):869-73
references.pmid: 15477625
references.citation: J Bone Miner Res. 2004 Dec;19(12):1969-75
references.pmid: 15537439