Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study.
Canadian women over 50 years old were studied over a 10-year period to see if those who sustained a fracture (caused by minimal trauma) were receiving the recommended osteoporosis therapy. We found that approximately half of these women were not being treated, indicating a significant care gap in osteoporosis treatment.


BACKGROUND
Prevalent fragility fracture strongly predicts future fracture. Previous studies have indicated that women with fragility fractures are not receiving the indicated treatment. We aimed to describe post fracture care in Canadian women using a large, population-based prospective cohort that began in 1995-1997.


METHODS
We followed 5,566 women over 50 years of age from across Canada over a period of 10 years in the Canadian Multicentre Osteoporosis Study. Information on medication use and incident clinical fragility fractures was obtained during a yearly questionnaire or interview and fractures were confirmed by radiographic/medical reports.


RESULTS
Over the 10-year study period, 42-56% of women with yearly incident clinical fragility fractures were not treated with an osteoporosis medication. During year 1 of the study, 22% of the women who had experienced a fragility fracture were on treatment with a bisphosphonate and 26% were on hormone therapy (HT). We were not able to differentiate HT use for menopause symptoms vs osteoporosis. Use of bisphosphonate therapy increased over time; odds ratio (OR) for use at year 10 compared to use at year 1 was 3.65 (95% confidence interval (CI) 1.83-7.26). In contrast, HT use declined, with an OR of 0.07 (95%CI 0.02-0.24) at year 10 compared to year 1 of the study.


CONCLUSIONS
In a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures. Although bisphosphonate therapy usage improved over time, a substantial gap remains.
Fraser
L-A
LA
Departments of Epidemiology and Medicine, Hamilton Health Sciences-Chedoke Site, McMaster University, 1200 Main Street West, Hamilton, ON L8N3Z5, Canada.
Ioannidis
G
G
Adachi
J D
JD
Pickard
L
L
Kaiser
S M
SM
Prior
J
J
Brown
J P
JP
Hanley
D A
DA
Olszynski
W P
WP
Anastassiades
T
T
Jamal
S
S
Josse
R
R
Goltzman
D
D
Papaioannou
A
A
D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D003695:Delivery of Health Care / Q000639:trends; D004164:Diphosphonates / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000517:prevention & control*; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies
D050071:Bone Density Conservation Agents; D004164:Diphosphonates