Equal treatment: no evidence of gender inequity in osteoporosis management in a coordinator-based fragility fracture screening program

Abstract

Needs-based analyses show no difference by gender in treatment of high-risk fragility fracture patients. An intensive coordinator-based fracture prevention model adopted in Ontario, Canada was not associated with gender inequity in OP treatment of fragility fracture patients after fracture risk adjustment.

Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort

“…Ansari et al . [ 20 ] demonstrated similar rates of treatment initiation between sexes with 66% of high-risk men and 68% of high-risk women (68%) started on anti-osteoporosis medications within six months of initial fracture–a prescription rate much higher than what we found (26%). One possible explanation for this discrepancy beyond the structured screening program is our relatively short duration of post-operative follow-up.…”

“…Our findings suggest a role for structured screening and treatment programs to avoid disparities in secondary prevention of fragility fractures between sexes and patients of varying ages. Recently, evidence presented from the Ontario Osteoporosis Strategy program suggests that standardized screening facilitates medication prescription and can eliminate sex- and age-based health inequities in secondary fracture prevention [ 20 , 56 ]. Ansari et al .…”

“…Indigenous race was inclusive of American Indians, Native Alaskans, Native Hawaiians and Pacific Islanders. We included additional exposure variables thought to be confounders based on existing literature [ 17 , 20 , 50 ] and clinical judgement. These included BMI, ASA score, mFI5 score, surgical fixation versus replacement, standardized hip fracture protocols, medical co-management and hospital length of stay [ 26 ].…”

“…In fact, a Public Health Agency of Canada report on the osteoporosis care gap found that the percentage of patients prescribed anti-osteoporosis medications following fracture decreased in the 2010s compared to previous decades [19]. Accordingly, current guidelines have encouraged the use of systemic screening and treatment protocols, such as Fracture Liaison Services, in order to minimize the effect of unconscious biases that could inhibit initiation of anti-osteoporotic medications in certain groups [20][21][22]. This strategy was, in part, likely motivated by several historical studies documenting the failure of practitioners to recognize or treat osteoporosis in male patients [23][24][25].…”

Racial and Ethnic Disparities in Bone Health and Outcomes in the United States

“…Studies such as MrOS have increased our knowledge on bone health in men, but we still observe lower screening and treatment provided for men, even in older age. ( 110 ) Unfortunately, there are little data on screening rates by race and ethnicity in men, identifying another need in the field. Differences in screening may be due to sex of providers, such that female providers are more likely to refer patients for screening compared with male providers.…”