title: Osteoporosis management and fractures in the Métis of Ontario, Canada.
abstract: Half of Métis citizens, compared to less than 10 % of the general population of Ontario, reside in northern regions, with little access to bone mineral density (BMD) testing. Métis citizens had lower sex-specific and age-standardized rates of BMD testing, yet similar rates of fracture (both sexes) and pharmacotherapy (women only).
  
  
  OBJECTIVE
  To examine osteoporosis management and common osteoporosis-related fractures among Métis citizens compared to the general population of older adults residing in Ontario.
  
  
  METHODS
  We linked healthcare (medical and pharmacy) utilization and administrative (demographic) databases with the Métis Nation of Ontario citizenship registry to estimate osteoporosis management (bone mineral density [BMD] testing, pharmacotherapy) and fractures (hip, humerus, radius/ulna) among adults aged ≥50 years, from April 1, 2006 to March 31, 2011. Pharmacotherapy data were limited to residents aged ≥65 years. Sex-specific and age-standardized rates were compared between the Métis and the general population. Multivariable logistic regression was used to compare rates of BMD testing after controlling for differences in age and region of residence between the Métis and the general population.
  
  
  RESULTS
  We studied 4219 Métis citizens (55 % men), and 140 (3 %) experienced a fracture. Half of Métis citizens, compared to less than 10 % of the general population of Ontario, resided in northern regions. We identified significantly lower sex-specific and age-standardized rates of BMD testing among Métis compared to the general population, yet found little difference in fracture rates (both sexes) or pharmacotherapy (women only). Differences in BMD testing disappeared after adjusting for region of residence among women yet remained significant among men.
  
  
  CONCLUSIONS
  Despite finding significantly lower rates of osteoporosis management among men, Métis men and women were found to have similar age-standardized fracture rates to the general population.
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Racquel
authors.initials: R
authors.lastname: Jandoc
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Jembere
authors.forename: Saba
authors.initials: S
authors.lastname: Khan
authors.forename: Storm J
authors.initials: SJ
authors.lastname: Russell
authors.forename: Yvon
authors.initials: Y
authors.lastname: Allard
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cadarette
mesh_terms: D000368:Aged; D015519:Bone Density; D019468:Disease Management; D005260:Female; D006801:Humans; D007198:Indians, North American; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010024:Osteoporosis / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology / Q000628:therapy*