Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2004

Open Access 01-12-2004 | Research article

The osteoporosis care gap in Canada

Authors: A Papaioannou, L Giangregorio, B Kvern, P Boulos, G Ioannidis, JD Adachi

Published in: BMC Musculoskeletal Disorders | Issue 1/2004

Login to get access

Abstract

Background

The presence of a fragility fracture is a major risk factor for osteoporosis, and should be an indicator for osteoporosis diagnosis and therapy. However, the extent to which patients who fracture are assessed and treated for osteoporosis is not clear.

Methods

We performed a review of the literature to identify the practice patterns in the diagnosis and treatment of osteoporosis in adults over the age of 40 who experience a fragility fracture in Canada. Searches were performed in MEDLINE (1966 to January 2, 2003) and CINAHL (1982 to February 1, 2003) databases.

Results

There is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. The proportion of individuals with a fragility fracture who received an osteoporosis diagnostic test or physician diagnosis ranged from 1.7% to 50%. Therapies such as hormone replacement therapy, bisphosphonates or calcitonin were being prescribed to 5.2% to 37.5% of patients. Calcium and vitamin D supplement intake was variable, and ranged between 2.8% to 61.6% of patients.

Conclusion

Many Canadians who experience fragility fracture are not receiving osteoporosis management for the prevention of future fractures.
Literature
1.
go back to reference Hellekson KL: NIH releases statement on osteoporosis prevention, diagnosis, and therapy. Am Fam Physician. 2002, 66: 161-162.PubMed Hellekson KL: NIH releases statement on osteoporosis prevention, diagnosis, and therapy. Am Fam Physician. 2002, 66: 161-162.PubMed
2.
go back to reference Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N: Diagnosis and management of vertebral fractures in elderly adults. Am J Med. 2002, 113: 220-228. 10.1016/S0002-9343(02)01190-7.CrossRefPubMed Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N: Diagnosis and management of vertebral fractures in elderly adults. Am J Med. 2002, 113: 220-228. 10.1016/S0002-9343(02)01190-7.CrossRefPubMed
3.
go back to reference Davis JW, Grove JS, Wasnich RD, Ross PD: Spatial relationships between prevalent and incident spine fractures. Bone. 1999, 24: 261-264. 10.1016/S8756-3282(98)00176-8.CrossRefPubMed Davis JW, Grove JS, Wasnich RD, Ross PD: Spatial relationships between prevalent and incident spine fractures. Bone. 1999, 24: 261-264. 10.1016/S8756-3282(98)00176-8.CrossRefPubMed
4.
go back to reference Wasnich RD, Davis JW, Ross PD: Spine fracture risk is predicted by non-spine fractures. Osteoporos Int. 1994, 4: 1-5.CrossRefPubMed Wasnich RD, Davis JW, Ross PD: Spine fracture risk is predicted by non-spine fractures. Osteoporos Int. 1994, 4: 1-5.CrossRefPubMed
5.
go back to reference Brown JP, Josse RG: 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002, 167: S1-34.PubMedPubMedCentral Brown JP, Josse RG: 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002, 167: S1-34.PubMedPubMedCentral
6.
go back to reference Castel H, Bonneh DY, Sherf M, Liel Y: Awareness of osteoporosis and compliance with management guidelines in patients with newly diagnosed low-impact fractures. Osteoporos Int. 2001, 12: 559-564. 10.1007/s001980170077.CrossRefPubMed Castel H, Bonneh DY, Sherf M, Liel Y: Awareness of osteoporosis and compliance with management guidelines in patients with newly diagnosed low-impact fractures. Osteoporos Int. 2001, 12: 559-564. 10.1007/s001980170077.CrossRefPubMed
7.
go back to reference Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA: Treatment of osteoporosis: are physicians missing an opportunity?. J Bone Joint Surg Am. 2000, 82-A: 1063-1070.PubMed Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA: Treatment of osteoporosis: are physicians missing an opportunity?. J Bone Joint Surg Am. 2000, 82-A: 1063-1070.PubMed
8.
go back to reference Gardner MJ, Flik KR, Mooar P, Lane JM: Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am. 2002, 84-A: 1342-1348.PubMed Gardner MJ, Flik KR, Mooar P, Lane JM: Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am. 2002, 84-A: 1342-1348.PubMed
9.
go back to reference Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH: Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002, 162: 2217-2222. 10.1001/archinte.162.19.2217.CrossRefPubMed Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH: Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002, 162: 2217-2222. 10.1001/archinte.162.19.2217.CrossRefPubMed
10.
go back to reference Onder G, Pedone C, Gambassi G, Landi F, Cesari M, Bernabei R: Treatment of osteoporosis among older adults discharged from hospital in Italy. Eur J Clin Pharmacol. 2001, 57: 599-604. 10.1007/s002280100370.CrossRefPubMed Onder G, Pedone C, Gambassi G, Landi F, Cesari M, Bernabei R: Treatment of osteoporosis among older adults discharged from hospital in Italy. Eur J Clin Pharmacol. 2001, 57: 599-604. 10.1007/s002280100370.CrossRefPubMed
11.
go back to reference Riley RL, Carnes ML, Gudmundsson A, Elliott ME: Outcomes and secondary prevention strategies for male hip fractures. Ann Pharmacother. 2002, 36: 17-23. 10.1345/aph.1A094.CrossRefPubMed Riley RL, Carnes ML, Gudmundsson A, Elliott ME: Outcomes and secondary prevention strategies for male hip fractures. Ann Pharmacother. 2002, 36: 17-23. 10.1345/aph.1A094.CrossRefPubMed
12.
go back to reference Simonelli C, Chen YT, Morancey J, Lewis AF, Abbott TA: Evaluation and Management of Osteoporosis Following Hospitalization for Low-impact Fracture. J Gen Intern Med. 2003, 18: 17-22. 10.1046/j.1525-1497.2003.20387.x.CrossRefPubMedPubMedCentral Simonelli C, Chen YT, Morancey J, Lewis AF, Abbott TA: Evaluation and Management of Osteoporosis Following Hospitalization for Low-impact Fracture. J Gen Intern Med. 2003, 18: 17-22. 10.1046/j.1525-1497.2003.20387.x.CrossRefPubMedPubMedCentral
14.
go back to reference Khan KS, ter Riet G, Popay J, Nixon J, Kleijnen J: Conducting the Review (stage 2): Study quality assessment (phase 5). CRD Report Number 4. 2001, Centre for Reviews and Dissemination, University of York, 1-20. Khan KS, ter Riet G, Popay J, Nixon J, Kleijnen J: Conducting the Review (stage 2): Study quality assessment (phase 5). CRD Report Number 4. 2001, Centre for Reviews and Dissemination, University of York, 1-20.
15.
go back to reference Juby AG, Geus-Wenceslau CM: Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int. 2002, 13: 205-210. 10.1007/s001980200015.CrossRefPubMed Juby AG, Geus-Wenceslau CM: Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int. 2002, 13: 205-210. 10.1007/s001980200015.CrossRefPubMed
16.
go back to reference Khan SA, de Geus C, Holroyd B, Russell AS: Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med. 2001, 161: 1309-1312. 10.1001/archinte.161.10.1309.CrossRefPubMed Khan SA, de Geus C, Holroyd B, Russell AS: Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med. 2001, 161: 1309-1312. 10.1001/archinte.161.10.1309.CrossRefPubMed
17.
go back to reference Papaioannou A, Wiktorowicz ME, Adachi JD, Goeree R, Papadimitropoulos E, Bedard M, Brazil K, Parkinson W, Weaver B: Mortality, Independence in Living and Re-fracture, One Year Following Hip Fracture in Canadians. J Soc Obstet Gynaecol Can. 2000, 22: 591-597. Papaioannou A, Wiktorowicz ME, Adachi JD, Goeree R, Papadimitropoulos E, Bedard M, Brazil K, Parkinson W, Weaver B: Mortality, Independence in Living and Re-fracture, One Year Following Hip Fracture in Canadians. J Soc Obstet Gynaecol Can. 2000, 22: 591-597.
18.
go back to reference Hajcsar EE, Hawker G, Bogoch ER: Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ. 2000, 163: 819-822.PubMedPubMedCentral Hajcsar EE, Hawker G, Bogoch ER: Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ. 2000, 163: 819-822.PubMedPubMedCentral
19.
go back to reference Juby AG, Davis P: A prospective evaluation of the awareness, knowledge, risk factors and current treatment of osteoporosis in a cohort of elderly subjects. Osteoporos Int. 2001, 12: 617-622. 10.1007/s001980170060.CrossRefPubMed Juby AG, Davis P: A prospective evaluation of the awareness, knowledge, risk factors and current treatment of osteoporosis in a cohort of elderly subjects. Osteoporos Int. 2001, 12: 617-622. 10.1007/s001980170060.CrossRefPubMed
20.
go back to reference Rucker D, Allan JA, Fick GH, Hanley DA: Vitamin D insufficiency in a population of healthy western Canadians. CMAJ. 2002, 166: 1517-1524.PubMedPubMedCentral Rucker D, Allan JA, Fick GH, Hanley DA: Vitamin D insufficiency in a population of healthy western Canadians. CMAJ. 2002, 166: 1517-1524.PubMedPubMedCentral
21.
go back to reference Ridout R, Hawker GA: Use of bone densitometry by Ontario family physicians. Osteoporos Int. 2000, 11: 393-399. 10.1007/s001980070105.CrossRefPubMed Ridout R, Hawker GA: Use of bone densitometry by Ontario family physicians. Osteoporos Int. 2000, 11: 393-399. 10.1007/s001980070105.CrossRefPubMed
22.
go back to reference Suarez-Almazor M, Homik JE, Messina D, Davis P: Attitudes and beliefs of family physicians and gynecologists in relation to the prevention and treatment of osteoporosis. J Bone Miner Res. 1997, 12: 1100-1107.CrossRefPubMed Suarez-Almazor M, Homik JE, Messina D, Davis P: Attitudes and beliefs of family physicians and gynecologists in relation to the prevention and treatment of osteoporosis. J Bone Miner Res. 1997, 12: 1100-1107.CrossRefPubMed
23.
go back to reference Fitt NS, Mitchell SL, Cranney A, Gulenchyn K, Huang M, Tugwell P: Influence of bone densitometry results on the treatment of osteoporosis. CMAJ. 2001, 164: 777-781.PubMedPubMedCentral Fitt NS, Mitchell SL, Cranney A, Gulenchyn K, Huang M, Tugwell P: Influence of bone densitometry results on the treatment of osteoporosis. CMAJ. 2001, 164: 777-781.PubMedPubMedCentral
24.
go back to reference Lee LT, Drake WM, Kendler DL: Intake of calcium and vitamin D in 3 Canadian long-term care facilities. J Am Diet Assoc. 2002, 102: 244-247. 10.1016/S0002-8223(02)90057-X.CrossRefPubMed Lee LT, Drake WM, Kendler DL: Intake of calcium and vitamin D in 3 Canadian long-term care facilities. J Am Diet Assoc. 2002, 102: 244-247. 10.1016/S0002-8223(02)90057-X.CrossRefPubMed
25.
go back to reference Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O'Fallon WM, Melton LJ,III: Osteoporosis intervention following distal forearm fractures: a missed opportunity?. Arch Intern Med. 2002, 162: 421-426. 10.1001/archinte.162.4.421.CrossRefPubMed Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O'Fallon WM, Melton LJ,III: Osteoporosis intervention following distal forearm fractures: a missed opportunity?. Arch Intern Med. 2002, 162: 421-426. 10.1001/archinte.162.4.421.CrossRefPubMed
26.
go back to reference Bellantonio S, Fortinsky R, Prestwood K: How well are community-living women treated for osteoporosis after hip fracture?. J Am Geriatr Soc. 2001, 49: 1197-1204. 10.1046/j.1532-5415.2001.49237.x.CrossRefPubMed Bellantonio S, Fortinsky R, Prestwood K: How well are community-living women treated for osteoporosis after hip fracture?. J Am Geriatr Soc. 2001, 49: 1197-1204. 10.1046/j.1532-5415.2001.49237.x.CrossRefPubMed
27.
go back to reference Blendon RJ, Donelan K, Leitman R, Epstein A, Cantor JC, Cohen AB, Morrison I, Moloney T, Koeck C, Levitt SW: Physicians' perspectives on caring for patients in the United States, Canada, and West Germany. N Engl J Med. 1993, 328: 1011-1016. 10.1056/NEJM199304083281407.CrossRefPubMed Blendon RJ, Donelan K, Leitman R, Epstein A, Cantor JC, Cohen AB, Morrison I, Moloney T, Koeck C, Levitt SW: Physicians' perspectives on caring for patients in the United States, Canada, and West Germany. N Engl J Med. 1993, 328: 1011-1016. 10.1056/NEJM199304083281407.CrossRefPubMed
28.
go back to reference Jaglal SB, Carroll J, Hawker G, McIsaac WJ, Jaakkimainen L, Cadarette SM, Cameron C, Davis D: How are family physicians managing osteoporosis? Quality study of their experiances and educational needs. Can Fam Physician. 2003, 49: 462-471.PubMedPubMedCentral Jaglal SB, Carroll J, Hawker G, McIsaac WJ, Jaakkimainen L, Cadarette SM, Cameron C, Davis D: How are family physicians managing osteoporosis? Quality study of their experiances and educational needs. Can Fam Physician. 2003, 49: 462-471.PubMedPubMedCentral
29.
go back to reference Papaioannou A, Parkinson W, Adachi J, O'Connor A, Jolly EE, Tugwell P, Bedard M: Women's decisions about hormone replacement therapy after education and bone densitometry. CMAJ. 1998, 159: 1253-1257.PubMedPubMedCentral Papaioannou A, Parkinson W, Adachi J, O'Connor A, Jolly EE, Tugwell P, Bedard M: Women's decisions about hormone replacement therapy after education and bone densitometry. CMAJ. 1998, 159: 1253-1257.PubMedPubMedCentral
Metadata
Title
The osteoporosis care gap in Canada
Authors
A Papaioannou
L Giangregorio
B Kvern
P Boulos
G Ioannidis
JD Adachi
Publication date
01-12-2004
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2004
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-5-11

Other articles of this Issue 1/2004

BMC Musculoskeletal Disorders 1/2004 Go to the issue