Skip to main content
Top
Published in: Osteoporosis International 4/2008

01-04-2008 | Original Article

The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study

Authors: A. Papaioannou, C. C. Kennedy, G. Ioannidis, Y. Gao, A. M. Sawka, D. Goltzman, A. Tenenhouse, L. Pickard, W. P. Olszynski, K. S. Davison, S. Kaiser, R. G. Josse, N. Kreiger, D. A. Hanley, J. C. Prior, J. P. Brown, T. Anastassiades, J. D. Adachi, CaMos Research Group

Published in: Osteoporosis International | Issue 4/2008

Login to get access

Abstract

Summary

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.

Introduction

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 ≥50 years.
Literature
1.
go back to reference National Osteoporosis Foundation (2002) America’s bone health: the state of osteoporosis and bone health. National Osteoporosis Foundation, Washington, DC. USA National Osteoporosis Foundation (2002) America’s bone health: the state of osteoporosis and bone health. National Osteoporosis Foundation, Washington, DC. USA
2.
go back to reference Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289PubMedCrossRef Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289PubMedCrossRef
3.
go back to reference Pluijm SM, Tromp AM, Smit JH et al (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15:1564–1572PubMedCrossRef Pluijm SM, Tromp AM, Smit JH et al (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15:1564–1572PubMedCrossRef
4.
go back to reference Burger H, Van Daele PL, Grashuis K et al (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157PubMedCrossRef Burger H, Van Daele PL, Grashuis K et al (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157PubMedCrossRef
5.
go back to reference Jackson SA, Tenenhouse A, Robertson L (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11:680–687PubMedCrossRef Jackson SA, Tenenhouse A, Robertson L (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11:680–687PubMedCrossRef
6.
go back to reference Kanis JA, Johnell O, Oden A et al (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674PubMedCrossRef Kanis JA, Johnell O, Oden A et al (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674PubMedCrossRef
7.
go back to reference Melton LJ 3rd, Chrischilles EA, Cooper C et al (2005) How many women have osteoporosis? JBMR Anniversary Classic. JBMR, Volume 7, Number 9, 1992. J Bone Miner Res 20:886–892PubMedCrossRef Melton LJ 3rd, Chrischilles EA, Cooper C et al (2005) How many women have osteoporosis? JBMR Anniversary Classic. JBMR, Volume 7, Number 9, 1992. J Bone Miner Res 20:886–892PubMedCrossRef
8.
go back to reference Forsen L, Sogaard AJ, Meyer HE et al (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78PubMedCrossRef Forsen L, Sogaard AJ, Meyer HE et al (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78PubMedCrossRef
9.
go back to reference Jiang HX, Majumdar SR, Dick DA et al (2005) Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res 20:494–500PubMedCrossRef Jiang HX, Majumdar SR, Dick DA et al (2005) Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res 20:494–500PubMedCrossRef
10.
go back to reference Hawkes WG, Wehren L, Orwig D et al (2006) Gender differences in functioning after hip fracture. J Gerontol A Biol Sci Med Sci 61:495–499PubMed Hawkes WG, Wehren L, Orwig D et al (2006) Gender differences in functioning after hip fracture. J Gerontol A Biol Sci Med Sci 61:495–499PubMed
11.
go back to reference Osnes EK, Lofthus CM, Meyer HE et al (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574PubMedCrossRef Osnes EK, Lofthus CM, Meyer HE et al (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574PubMedCrossRef
12.
go back to reference Marottoli RA, Berkman LF, Leo-Summers L et al (1994) Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE cohort. Established populations for epidemiologic studies of the elderly. Am J Public Health 84:1807–1812PubMed Marottoli RA, Berkman LF, Leo-Summers L et al (1994) Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE cohort. Established populations for epidemiologic studies of the elderly. Am J Public Health 84:1807–1812PubMed
13.
go back to reference Papaioannou A, Wiktorowicz M, Adachi JD et al (2000) Mortality, independence in living, and re-fracture, one year following hip fractures in Canadians. J Obstet Gynaecol Can 22:591–597 Papaioannou A, Wiktorowicz M, Adachi JD et al (2000) Mortality, independence in living, and re-fracture, one year following hip fractures in Canadians. J Obstet Gynaecol Can 22:591–597
14.
go back to reference Elliot-Gibson V, Bogoch ER, Jamal SA et al (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778PubMedCrossRef Elliot-Gibson V, Bogoch ER, Jamal SA et al (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778PubMedCrossRef
15.
go back to reference Papaioannou A, Giangregorio L, Kvern B et al (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5:11PubMedCrossRef Papaioannou A, Giangregorio L, Kvern B et al (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5:11PubMedCrossRef
16.
go back to reference Giangregorio L, Papaioannou A, Cranney A et al (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305PubMedCrossRef Giangregorio L, Papaioannou A, Cranney A et al (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305PubMedCrossRef
17.
go back to reference National Osteoporosis Foundation [homepage on the Internet] Washington, DC. USA. National Osteoporosis Foundation, c2003 [cited June 2006]. Physician’s Guide to Prevention and Treatment of Osteoporosis; [about 1 screen]. Available from: http://noforg/physguide/ National Osteoporosis Foundation [homepage on the Internet] Washington, DC. USA. National Osteoporosis Foundation, c2003 [cited June 2006]. Physician’s Guide to Prevention and Treatment of Osteoporosis; [about 1 screen]. Available from: http://​noforg/​physguide/​
18.
go back to reference (1996) Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada. CMAJ 155:1113–1133 (1996) Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada. CMAJ 155:1113–1133
19.
go back to reference Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167:S1–S34PubMed Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167:S1–S34PubMed
20.
go back to reference Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382PubMedCrossRef Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382PubMedCrossRef
21.
go back to reference Klotzbuecher CM, Ross PD, Landsman PB et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRef Klotzbuecher CM, Ross PD, Landsman PB et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRef
22.
go back to reference Phillipov G, Phillips PJ, Leach G et al (1998) Public perceptions and self-reported prevalence of osteoporosis in South Australia. Osteoporos Int 8:552–556PubMedCrossRef Phillipov G, Phillips PJ, Leach G et al (1998) Public perceptions and self-reported prevalence of osteoporosis in South Australia. Osteoporos Int 8:552–556PubMedCrossRef
23.
go back to reference Juby AG, Davis P (2001) A prospective evaluation of the awareness, knowledge, risk factors and current treatment of osteoporosis in a cohort of elderly subjects. Osteoporos Int 12:617–622PubMedCrossRef Juby AG, Davis P (2001) A prospective evaluation of the awareness, knowledge, risk factors and current treatment of osteoporosis in a cohort of elderly subjects. Osteoporos Int 12:617–622PubMedCrossRef
24.
go back to reference Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163:819–822PubMed Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163:819–822PubMed
25.
go back to reference Kreiger N, Tenenhouse A, Joseph L et al (2002) The Canadian Multicenter Osteoporosis Study (CaMos): background, rationale, methods. Can J Aging 18:376–387 Kreiger N, Tenenhouse A, Joseph L et al (2002) The Canadian Multicenter Osteoporosis Study (CaMos): background, rationale, methods. Can J Aging 18:376–387
26.
go back to reference Genant HK, Grampp S, Gluer CC et al (1994) Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9:1503–1514PubMedCrossRef Genant HK, Grampp S, Gluer CC et al (1994) Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9:1503–1514PubMedCrossRef
27.
go back to reference Tenenhouse A, Joseph L, Kreiger N et al (2000) Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 11:897–904PubMedCrossRef Tenenhouse A, Joseph L, Kreiger N et al (2000) Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 11:897–904PubMedCrossRef
28.
go back to reference Sawka AM, Thabane L, Papaioannou A et al (2005) A systematic review of the effect of alendronate on bone mineral density in men. J Clin Densitom 8:7–13PubMedCrossRef Sawka AM, Thabane L, Papaioannou A et al (2005) A systematic review of the effect of alendronate on bone mineral density in men. J Clin Densitom 8:7–13PubMedCrossRef
29.
go back to reference Ringe JD, Faber H, Farahmand P et al (2006) Efficacy of risedronate in men with primary and secondary osteoporosis: results of a 1-year study. Rheumatol Int 26:427–431PubMedCrossRef Ringe JD, Faber H, Farahmand P et al (2006) Efficacy of risedronate in men with primary and secondary osteoporosis: results of a 1-year study. Rheumatol Int 26:427–431PubMedCrossRef
30.
go back to reference Sawka AM, Papaioannou A, Adachi JD et al (2005) Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women. BMC Musculoskelet Disord 6:39PubMedCrossRef Sawka AM, Papaioannou A, Adachi JD et al (2005) Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women. BMC Musculoskelet Disord 6:39PubMedCrossRef
31.
go back to reference Orwoll E, Ettinger M, Weiss S et al (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610PubMedCrossRef Orwoll E, Ettinger M, Weiss S et al (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610PubMedCrossRef
32.
go back to reference Simonelli C, Killeen K, Mehle S et al (2002) Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc 77:334–338PubMed Simonelli C, Killeen K, Mehle S et al (2002) Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc 77:334–338PubMed
33.
go back to reference Jaglal SB, McIsaac WJ, Hawker G et al (2003) Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporos Int 14:672–676PubMedCrossRef Jaglal SB, McIsaac WJ, Hawker G et al (2003) Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporos Int 14:672–676PubMedCrossRef
34.
go back to reference Papaioannou A, Coker E, Kennedy CK et al (2004) A multi-faceted post fracture care model: the fracture? Think osteoporosis! Program. J Bone Miner Res 19:S318 Papaioannou A, Coker E, Kennedy CK et al (2004) A multi-faceted post fracture care model: the fracture? Think osteoporosis! Program. J Bone Miner Res 19:S318
35.
go back to reference Bogoch ER, Elliot-Gibson V, Beaton DE et al (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 88:25–34PubMedCrossRef Bogoch ER, Elliot-Gibson V, Beaton DE et al (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 88:25–34PubMedCrossRef
36.
go back to reference Harrington JT, Barash HL, Day S et al (2005) Redesigning the care of fragility fracture patients to improve osteoporosis management: a health care improvement project. Arthritis Rheum 53:198–204PubMedCrossRef Harrington JT, Barash HL, Day S et al (2005) Redesigning the care of fragility fracture patients to improve osteoporosis management: a health care improvement project. Arthritis Rheum 53:198–204PubMedCrossRef
37.
go back to reference Kmetic A, Joseph L, Berger C et al (2002) Multiple imputation to account for missing data in a survey: estimating the prevalence of osteoporosis. Epidemiology 13:437–444PubMedCrossRef Kmetic A, Joseph L, Berger C et al (2002) Multiple imputation to account for missing data in a survey: estimating the prevalence of osteoporosis. Epidemiology 13:437–444PubMedCrossRef
Metadata
Title
The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study
Authors
A. Papaioannou
C. C. Kennedy
G. Ioannidis
Y. Gao
A. M. Sawka
D. Goltzman
A. Tenenhouse
L. Pickard
W. P. Olszynski
K. S. Davison
S. Kaiser
R. G. Josse
N. Kreiger
D. A. Hanley
J. C. Prior
J. P. Brown
T. Anastassiades
J. D. Adachi
CaMos Research Group
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 4/2008
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-007-0483-0

Other articles of this Issue 4/2008

Osteoporosis International 4/2008 Go to the issue

Letter to the Editor

Expressing fracture risk