A S Mendis1, K Ganda1, M J Seibel2. 1. Department of Endocrinology and Metabolism, Level 6 Concord Medical Centre, Concord Repatriation General Hospital, Hospital Road, Concord West, NSW, 2139, Australia. 2. Department of Endocrinology and Metabolism, Level 6 Concord Medical Centre, Concord Repatriation General Hospital, Hospital Road, Concord West, NSW, 2139, Australia. markus.seibel@sydney.edu.au.
Abstract
This study of current osteoporosis management patterns in general practice found that the majority of patients presenting to their local health practitioner with a recent low-trauma fracture was not managed appropriately. The analysis demonstrated that failure to investigate was highly predictive of failure to treat and that one of the major barriers to effective osteoporosis management is a lack of specific knowledge about who to investigate and treat. INTRODUCTION: Osteoporotic fractures are associated with significant morbidity and mortality. The current study aimed (i) to determine the number of patients with osteoporotic fractures who were not investigated or treated for osteoporosis by their primary care physician and (ii) to identify factors that contribute to the ongoing gap in osteoporosis care. METHODS: We conducted an observational retrospective study (2012-2014) using explicit medical record review at three major general practices in metropolitan Sydney. Patients aged 55 years or older who had a documented minimal trauma fracture (MTF) were identified. Data collected included demographics, prior fractures, testing for vitamin D/bone mineral density and initiation of osteoporosis pharmacotherapy. The main outcome measures included the number of patients who did not undergo the following: (i) a bone density scan, (ii) vitamin D measurement and/or (iii) initiation of osteoporosis pharmacotherapy. RESULTS: Of the 87 patients (69% female; mean age 71.7 years) with prevalent MTF, 55 (63%) were not referred for a bone density scan. Vitamin D levels were not measured in 36 patients (41%) and 55 patients (63%) did not receive specific osteoporosis pharmacotherapy. Failure to investigate was highly predictive of failure to treat (p < 0.001). The presence of major osteoporotic risk factors did not affect the likelihood of investigation or treatment, indicating that a major barrier to effective osteoporosis management was a lack of knowledge. CONCLUSION: Management of patients with MTF's in primary care is poor. Systems aimed at improving the identification and treatment of patients with osteoporotic fractures in this setting is required in order to close the osteoporosis care gap.
This study of current osteoporosis management patterns in general practice found that the majority of patients presenting to their local health practitioner with a recent low-trauma fracture was not managed appropriately. The analysis demonstrated that failure to investigate was highly predictive of failure to treat and that one of the major barriers to effective osteoporosis management is a lack of specific knowledge about who to investigate and treat. INTRODUCTION:Osteoporotic fractures are associated with significant morbidity and mortality. The current study aimed (i) to determine the number of patients with osteoporotic fractures who were not investigated or treated for osteoporosis by their primary care physician and (ii) to identify factors that contribute to the ongoing gap in osteoporosis care. METHODS: We conducted an observational retrospective study (2012-2014) using explicit medical record review at three major general practices in metropolitan Sydney. Patients aged 55 years or older who had a documented minimal trauma fracture (MTF) were identified. Data collected included demographics, prior fractures, testing for vitamin D/bone mineral density and initiation of osteoporosis pharmacotherapy. The main outcome measures included the number of patients who did not undergo the following: (i) a bone density scan, (ii) vitamin D measurement and/or (iii) initiation of osteoporosis pharmacotherapy. RESULTS: Of the 87 patients (69% female; mean age 71.7 years) with prevalent MTF, 55 (63%) were not referred for a bone density scan. Vitamin D levels were not measured in 36 patients (41%) and 55 patients (63%) did not receive specific osteoporosis pharmacotherapy. Failure to investigate was highly predictive of failure to treat (p < 0.001). The presence of major osteoporotic risk factors did not affect the likelihood of investigation or treatment, indicating that a major barrier to effective osteoporosis management was a lack of knowledge. CONCLUSION: Management of patients with MTF's in primary care is poor. Systems aimed at improving the identification and treatment of patients with osteoporotic fractures in this setting is required in order to close the osteoporosis care gap.
Entities:
Keywords:
Bone density; Investigation; Management; Osteoporosis; Primary care
Authors: L Pérez-Edo; M Ciria Recasens; C Castelo-Branco; P Orozco López; A Gimeno Marqués; C Pérez; J Manasanch Dalmau Journal: Osteoporos Int Date: 2004-01-27 Impact factor: 4.507
Authors: W D Leslie; L M Giangregorio; M Yogendran; M Azimaee; S Morin; C Metge; P Caetano; L M Lix Journal: Osteoporos Int Date: 2011-04-08 Impact factor: 4.507
Authors: Beatrice J Edwards; Andrew D Bunta; Christine Simonelli; Mark Bolander; Lorraine A Fitzpatrick Journal: Clin Orthop Relat Res Date: 2007-08 Impact factor: 4.176
Authors: Luai Awad Ahmed; Jacqueline R Center; Ashild Bjørnerem; Dana Bluic; Ragnar M Joakimsen; Lone Jørgensen; Haakon E Meyer; Nguyen D Nguyen; Tuan V Nguyen; Tone K Omsland; Jan Størmer; Grethe S Tell; Tineke Acm van Geel; John A Eisman; Nina Emaus Journal: J Bone Miner Res Date: 2013-10 Impact factor: 6.741
Authors: Aaron T Seaman; Melissa Steffen; Taisha Doo; Heather S Healy; Samantha L Solimeo Journal: J Gen Intern Med Date: 2018-07-27 Impact factor: 5.128
Authors: H Spechbach; I Fabreguet; E Saule; M Hars; J Stirnemann; S Ferrari; R Rizzoli; T Chevalley Journal: Osteoporos Int Date: 2019-02-28 Impact factor: 4.507
Authors: M K Skjødt; S Khalid; M Ernst; K H Rubin; D Martinez-Laguna; A Delmestri; M K Javaid; C Cooper; C Libanati; E Toth; B Abrahamsen; D Prieto-Alhambra Journal: Osteoporos Int Date: 2020-03-17 Impact factor: 4.507