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01-12-2021 | Osteoporosis | Original Article

The yawning gap between osteoporosis diagnosis and treatment after a fragility fracture in Mexico

Authors: Salvador Israel Macías-Hernández, Miriam Macarena Degollado-Rodríguez, Horacio Maldonado-Sánchez, Andrea Olascoaga-Gómez de León, Roberto Coronado-Zarco, Tania Inés Nava-Bringas, Esperanza Ramírez-Pérez, Eva Cruz-Medina, Rolando Espinosa-Morales, Juan Daniel Morones-Alba

Published in: Archives of Osteoporosis | Issue 1/2021

Abstract

Summary

This study shows a diagnostic and therapeutic gap for osteoporosis in patients with fragility fractures of the hip, distal radius, and vertebrae. Patients with fragility fractures treated in Mexico fail to receive an osteoporosis diagnosis, referral, and follow-up treatment. The therapeutic gap is higher than reported in other countries.

Introduction

Osteoporosis is a highly prevalent and disabling disease. While there is typically a gap between osteoporosis diagnosis and treatment after a fragility fracture, this gap has not been measured in Mexico. The study aimed to describe and quantify the gap between osteoporosis diagnosis and treatment after an incident fragility fracture.

Materials and methods

A descriptive and 3-year retrospective chart review study was conducted on patients over the age of 50 with a diagnosis of an incident acute low-energy fracture of either the hip, distal radius, or vertebrae.

Results

We included 838 patients with a mean age of 76.3 ± 12.2 years. The sample was mostly women (665 participants, 79.4%); 589 (70.3%) had a hip fracture, 173 (20.6%) had a distal radius fracture, and 76 (9.1%) had a vertebral fracture. Only 28 (3.3%) had a previous diagnosis and were taking a pharmacological treatment for osteoporosis; 11 (1.3%) received their diagnosis while hospitalized. Immediately after the fracture, and 1 and 3 years later, 144 (17.1%), 71 (8.4%), and 96 (11.4%) respectively received a pharmacological treatment, 195 (23.2%), 65 (7.7%), and 45 (5.3%) supplementation, and 16 (1.9%), 16 (1.9%), and 21 (2.5%) a non-pharmacologic treatment. No significant differences in treatment prescriptions were found after a second or third fracture.

Conclusion

The study quantifies the too high frequency of failure to diagnose and treat osteoporosis in patients with fragility fractures. Measures should be established to reduce the yawning gap between osteoporosis diagnosis and treatment after a fragility fracture.

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795CrossRef

Levinson W, Altkorn D (1998) Primary prevention of postmenopausal osteoporosis. JAMA 280:1821–1822CrossRef

Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739CrossRef

Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, Curtis JR (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 30:79–92CrossRef

Gehlbach S, Saag KG, Adachi Greenspan SL, LaCroix AZ, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Sambrook PN, Silverman S, Siris ES, Watts NB, Lindsay R (2012) Previous fractures at multiple sites increase the risk for subsequent fractures: the Global Longitudinal Study of Osteoporosis in Women. J Bone Miner Res 27:645–653CrossRef

Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E, Sigurdsson G, Kanis JA (2017) Imminent risk of fracture after fracture. Osteoporos Int 28:775–780CrossRef

Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382CrossRef

Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773CrossRef

Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828CrossRef

10.

Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923CrossRef

11.

Crandall CJ, Newberry SJ, Diamant A, Lim YW, Gellad WF, Booth MJ, Motala A, Shekelle PG (2014) Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med 161:711–723CrossRef

12.

Ibarra LG (2013) las enfermedades y traumatismos del sistema músculo esquelético. Un análisis del Instituto Nacional de Rehabilitación de México, como base para su clasificación y prevención. National Institute of Rehabilitation, Mexico's, Ministry of Health. https://www.inr.gob.mx/Descargas/ops-oms/lasEnfermedadesTraumatismosSistemaMusculoEsqueletico.pdf. Accessed 10 Jan 2021

13.

Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRef

14.

Smektala R, Endres HG, Dasch B, Bonnaire F, Trampisch HJ, Pientka L (2009) Quality of care after distal radius fracture in Germany. Results of a fracture register of 1201 elderly patients. Unfallchirurg 112:46–54CrossRef

15.

Panneman MJ, Lips P, Sen SS, Herings RM (2004) Undertreatment with anti-osteoporotic drugs after hospitalization for fracture. Osteoporos Int 15:120–124CrossRef

16.

Gehlbach SH, Avrunin JS, Puleo E, Spaeth R (2007) Fracture risk and antiresorptive medication use in older women in the USA. Osteoporos Int 18:805–810CrossRef

17.

Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163:819–822PubMedPubMedCentral

18.

Bessett L, Ste-Marie LG, Jean S et al (2008) The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 19(1):79–86CrossRef

19.

Metge CJ, Leslie WD, Manness LJ, Yogendran M, Yuen CK, Kvern B, Maximizing Osteoporosis Management in Manitoba Steering Committee (2008) Post-fracture care for older women: gaps between optimal care and actual care. Can Fam Physician 54:1270–1276PubMedPubMedCentral

20.

Borgström F, Karlsson L, Ortsäter G, Norton N, Halbout P, Cooper C, Lorentzon M, McCloskey EV, Harvey NC, Javaid MK, Kanis JA, International Osteoporosis Foundation (2020) Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos 15:59CrossRef

21.

LeBlanc KE, Muncie HL Jr, LeBlanc LL (2014) Hip fracture: diagnosis, treatment, and secondary prevention. Am Fam Physician 89:945–951PubMed

22.

Castel H, Bonneh DY, Sherf M, Liel Y (2001) Awareness of osteoporosis and compliance with management guidelines in patients with newly diagnosed low-impact fractures. Osteoporos Int 12:559–564CrossRef

23.

Kanis JA, Cooper C, Rizzoli R, Reginster JY, Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF) (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30:3–44CrossRef

24.

Follin SL, Black JN, McDermott MT (2003) Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Pharmacotherapy 23:190–198CrossRef

25.

Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O'Fallon WM, Melton LJ 3rd (2002) Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med 162:421–426CrossRef

26.

Murillo B, Rodriguez O, Vanoli F, Iglesias S, Allende C (2016) Incidence of anti-osteoporosis diagnosis and treatment after distal radius fractures. HAND 11:64S–65S

27.

Bougioukli S, Κollia P, Koromila T, Varitimidis S, Hantes M, Karachalios T, Malizos ΚΝ, Dailiana ZH (2019) Failure in diagnosis and under-treatment of osteoporosis in elderly patients with fragility fractures. J Bone Miner Metab 37:327–335CrossRef

28.

Barton DW, Behrend CJ, Carmouche JJ (2019) Rates of osteoporosis screening and treatment following vertebral fracture. Spine J 19:411–417CrossRef

Title: The yawning gap between osteoporosis diagnosis and treatment after a fragility fracture in Mexico
Authors: Salvador Israel Macías-Hernández
Miriam Macarena Degollado-Rodríguez
Horacio Maldonado-Sánchez
Andrea Olascoaga-Gómez de León
Roberto Coronado-Zarco
Tania Inés Nava-Bringas
Esperanza Ramírez-Pérez
Eva Cruz-Medina
Rolando Espinosa-Morales
Juan Daniel Morones-Alba
Publication date: 01-12-2021
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-021-00926-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The yawning gap between osteoporosis diagnosis and treatment after a fragility fracture in Mexico

Abstract

Summary

Introduction

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Materials and methods

Results

Conclusion

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