title: A population-based analysis of the post-fracture care gap 1996-2008: the situation is not improving.
abstract: The post-fracture care gap has not narrowed in recent years. Following an initial improvement, rates of medication initiation have actually declined.
  
  
  BACKGROUND
  The current study characterizes temporal changes in post-fracture bone mineral density (BMD) testing or osteoporosis treatment initiation from 1996/1997 to 2007/2008.
  
  
  METHODS
  A population-based administrative data repository for Manitoba, Canada was accessed to identify non-traumatic fractures in individuals aged 50 years and older. Outcomes included BMD testing or dispensation of an osteoporosis medication in the 12 months following the fracture.
  
  
  RESULTS
  Thirty thousand nine hundred and twenty (30,920) fracture events met the inclusion criteria; 15,670 affected major osteoporotic fracture sites. Based on either BMD testing or treatment initiation, intervention rates reached a maximum of only 15.5% in 2003/2004, compared with 6.3% in 1996/1997, and 13.2% in 2007/2008 (p-for-trend < 0.001). Post-fracture BMD testing increased from 0.7% in 1996/1997 to 8.9% 2007/2008 (p-for-trend < 0.001). Osteoporosis medication use increased from 6.1% in 1996/1997 to 12.3% in 2001/2002 and then progressively declined to 5.9% by 2007/2008 (p-for-trend = 0.025). Similar trends were observed when only major osteoporotic fractures were included. The initiation of BMD testing or medication varied according to age, gender, geographic region, and income.
  
  
  CONCLUSIONS
  Despite increased attention to gaps in osteoporosis management post-fracture in the last 10 years, the situation has not improved: in 2007/20008, fewer than 20% of untreated individuals with a low-trauma fracture received intervention. Novel strategies are required to disseminate and implement best practices at the point of care to reduce the risk of recurrent fractures.
authors.affiliation: Department of Medicine, University of Manitoba, C5121 409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada. bleslie@sbgh.mb.ca
authors.forename: W D
authors.initials: WD
authors.lastname: Leslie
authors.forename: L M
authors.initials: LM
authors.lastname: Giangregorio
authors.forename: M
authors.initials: M
authors.lastname: Yogendran
authors.forename: M
authors.initials: M
authors.lastname: Azimaee
authors.forename: S
authors.initials: S
authors.lastname: Morin
authors.forename: C
authors.initials: C
authors.lastname: Metge
authors.forename: P
authors.initials: P
authors.lastname: Caetano
authors.forename: L M
authors.initials: LM
authors.lastname: Lix
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D015519:Bone Density / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D019468:Disease Management; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D055502:Secondary Prevention; D012737:Sex Factors
chemical_list: D050071:Bone Density Conservation Agents