The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

McCloskey, Eugène; Rathi, Jeetandera; Heijmans, Stéphane; Blagden, Mark; Cortet, Bernard; Czerwiński, E. J.; Hadji, Peyman; Payer, Juraj; Palmer, Kerry; Stad, Robert; O’Kelly, James; Papapoulos, Socrates E.

doi:10.1007/s00198-020-05557-z

Cited by 90 publications

(87 citation statements)

References 28 publications

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“…Although there is no reason for not following these recommendations, at least in high‐income countries with universal healthcare coverage, a wide treatment gap exists between recommended and actual practice. ( 22 ) With this in mind, we have performed a cohort study in the French national healthcare data base. The principal objective was to assess the short‐term consequences of severe osteoporotic fractures at different sites in terms of refracture and mortality.…”

Section: Introductionmentioning

confidence: 99%

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

et al. 2021

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Severe osteoporotic fractures (hip, proximal humerus, pelvic, vertebral and multiple rib fractures) carry an increased risk of mortality. This retrospective cohort study in the French national healthcare database aimed to estimate refracture and mortality rates after severe osteoporotic fractures at different sites, and to identify mortality‐related variables. A total of 356,895 patients hospitalized for severe osteoporotic fracture between 2009 and 2014 inclusive were analyzed. The cohort was followed for 2 to 8 years up to the study end or until the patient died. Data were extracted on subsequent hospitalizations, refracture events, treatments, comorbidities of interest and survival. Time to refracture and survival were described using Kaplan‐Meier analysis by site of fracture and overall. Mortality risk factors were identified using a Cox model. Hip fractures accounted for 60.4% of the sample (N = 215,672). In the 12 months following fracture, 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate was 6.3% (95% confidence interval [CI], 6.2%–6.3%), ranging from 4.0% (95% CI, 3.7%–4.3%) for multiple rib fractures to 7.8% (95% CI, 7.5%–8.1%) for pelvic fractures. Twelve‐month all‐cause mortality was 12.8% (95% CI, 12.7%–12.9%), ranging from 5.0% (95% CI, 4.7%–5.2%) for vertebral fractures to 16.6% (95% CI, 16.4%–16.7%) for hip fractures. Osteoporosis‐related mortality risk factors included fracture site, previous osteoporotic fracture (hazard ratio 1.21; 95% CI, 1.18–1.23), hip refracture (1.74; 95% CI, 1.71–1.77), and no prior osteoporosis treatment (1.24; 95% CI, 1.22–1.26). Comorbid cancer (3.15; 95% CI, 3.09–3.21) and liver disease (2.54; 95% CI, 2.40–2.68) were also strongly associated with mortality. In conclusion, severe osteoporotic fractures, including certain non‐hip nonvertebral fractures, carry a high burden in terms of mortality and refracture risk. However, most patients received no anti‐osteoporotic treatment. The findings emphasize the importance of better management of patients with severe fractures, and of developing effective strategies to reduce fracture risk in patients with osteoporosis. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Introductionmentioning

confidence: 99%

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

et al. 2021

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“…Osteoporosis is treatable and fractures can be prevented [1]. However, it remains largely undiagnosed and untreated [2][3][4]. Fewer than 20% of women and 10% of men experiencing a fragility fracture receive therapies to prevent further fractures [2,3,5].…”

Section: Introductionmentioning

confidence: 99%

Use of an electronic medical record dashboard to identify gaps in osteoporosis care

et al. 2021

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Summary Using an electronic medical record (EMR)-based dashboard, this study explored osteoporosis care gaps in primary care. Eighty-four physicians shared their practice activities related to bone mineral density testing, 10-year fracture risk calculation and treatment for those at high risk. Significant gaps in fracture risk calculation and osteoporosis management were identified. Purpose To identify care gaps in osteoporosis management focusing on Canadian clinical practice guidelines (CPG) related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk. Methods The ADVANTAGE OP EMR tool consists of an interactive algorithm to facilitate assessment and management of fracture risk using CPG. The FRAX® and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools were embedded to facilitate 10-year fracture risk calculation. Physicians managed patients as clinically indicated but with EMR reminders of guideline recommendations; participants shared practice level data on management activities after 18-month use of the tool. Results Eighty-four physicians (54%) of 154 who agreed to participate in this study shared their aggregate practice activities. Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture. Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed; most common reasons for this were intention to order BMD later (48%), physician belief that BMD was not required (15%) and patient refusal (20%). For patients with BMD completed, fracture risk was calculated in 29%; 19% were at high risk, of whom 37% were not treated with osteoporosis medications as recommended by CPG. Conclusion Despite access to CPG and fracture risk calculators through the ADVANTAGE OP EMR tool, significant gaps remain in fracture risk calculation and osteoporosis management. Additional strategies are needed to address this clinical inertia among family physicians.

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“…According to recent reports found that primary care physicians perceive OP as a silent disorder and that is obscure by several health problems as well as it receives less attention manage. [ 23 24 ] The present study will help ensure that primary care physicians take the needed responsibility and for following up bone quality of osteoporotic patients.…”

Section: Discussionmentioning

confidence: 99%

Potential cause affecting bone quality in Saudi Arabia

Al-Hariri

Goweiz

Aldhafery

et al. 2021

Journal of Family Medicine and Primary Care

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Background: Osteoporosis (OP) is a silent systemic disease characterized by decrements in bone mineral density (BMD) and bone microstructure. This study aimed to determine the status of bone quality as well as to investigate the relationship between the glycaemic; lipid; bone profiles; and the BMD. Methods: A retrospective study was conducted at KFHU, Al Khobar, Saudi Arabia analysis of patients who underwent BMD testing between the periods of 2016 to 2018. Based on the T scores, patients were classified as follows: normal (>−1.0), osteopenic (−1.0 to −2.5), or osteoporotic (≤−2.5). Details about medical and demographic information as well as metabolic and bone profiles (fasting blood glucose [FBG], glycated haemoglobin [HbA1c], cholesterol [Chol], high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides [TG], calcium [Ca], phosphorus [Ph], alkaline phosphatase [ALP], vitamin D 25OHD [Vit D]) were extracted from the medical records system. Results: Out of 4838 extracted profiles, there were 4196 females (85.1%). The mean glycaemic variables of patients showed an abnormal profile (FBG 118 ± 49 and HbA1c 6.6 ± 2). The mean T score showed that the majority of patients had either osteopenic (40%) or osteoporotic (24%) changed. Significant increase in mean HbA1c (7.6 ± 1.7) was obvious among the osteopenic patients when judged against the normal (7.5 ± 1.6; P < 0.033) and osteoporotic (7.4 ± 1.8; P < 0.037). Meanwhile, the mean serum ALP was significantly lower (81 ± 26) in the normal group than in the osteopenic (86 ± 33; P < 0.006) and osteoporotic groups (90 ± 40; P < 0.001). Finally, a linear, logistic regression analysis was found that Ca and ALP levels were significant predictors. Conclusion: This study finds that the main cause that affects bone quality in Saudi Arabia is diabetes mellitus and/or its related metabolic alteration. These results suggest that bone health is clinically significant and should be carefully assessed in diabetes patients.

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The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

Cited by 90 publications

References 28 publications

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

Use of an electronic medical record dashboard to identify gaps in osteoporosis care

Potential cause affecting bone quality in Saudi Arabia

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