Fragility Fractures and the Osteoporosis Care Gap: An International Phenomenon
A fragility fracture is a major risk factor for osteoporosis and future fractures. Therapeutic options are available that can reduce the risk of future fracture in individuals with a fragility fracture. Therefore, it is important to identify whether patients who experience fragility fracture are being assessed and treated for osteoporosis in order to reduce the risk of future fracture.
A systematic review of the literature produced 35 studies conducted in United Kingdom, New Zealand, Australia, South Africa, Israel, Denmark, France, Canada, the Netherlands and the United States demonstrating that many individuals in the who experience fragility fracture are not being diagnosed and treated for osteoporosis. An osteoporosis diagnosis was reported in 1- 45% of patients with fractures, laboratory tests were ordered for 1% – 49% and 1% – 32% of patients had bone density scans. Calcium/vitamin D and pharmacological therapy was reported in 2 – 62% and 1 – 65% of patients, respectively.
Osteoporosis treatment was recommended more often in women than men, and more often in patients with vertebral fractures than in patients with non-vertebral fractures. Older patients were more likely to be diagnosed with osteoporosis, but treatment was more likely in younger patients. A history of prior fracture was reported in 7% – 67% of patients. Between 1% and 22% of patients had a subsequent fracture during follow-up periods of 6 months to 5 years.
Falls assessments were not often reported; when they were, they were infrequently performed. A greater proportion of patients were diagnosed/treated during follow-up studies than in studies evaluating diagnosis/treatment on discharge from acute care. Ultimately, there is an international care gap between the occurrence of a fragility fracture and appropriate osteoporosis management. Future research should address barriers to appropriate management, and the efficacy of implementation strategies designed to close the osteoporosis care gap.