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The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study

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Abstract

Summary

We examined osteoporosis diagnosis/treatment in 2,187 community dwelling men age 50+. After five years in the study, 90% of men with fragility fractures remained undiagnosed and untreated for osteoporosis. The need to treat fragility fractures is well established in guidelines, and these numbers represent an important care gap.

Introduction

Whether physicians in the community are recognizing and appropriately treating osteoporosis and fragility fractures in men remains unknown. We examined the rate of diagnosis and treatment in community dwelling men participating in the Canadian Multicentre Osteoporosis Study (CaMos).

Methods

Between February 1996 and September 2002, 2,187 participants were recruited from nine sites across Canada and prospectively followed. Information on osteoporosis diagnosis, fractures, medications were collected annually by a detailed questionnaire. DXA examination of lumbar spine (L1-4) and hip were conducted at baseline and year five.

Results

Diagnosis and treatment in men with clinical fragility fractures was low: at baseline and year five only 2.3% and 10.3% of men with a clinical fracture reported an osteoporosis diagnosis, respectively. At year five, 90% of men with a clinical fragility fracture were untreated. Hip fractures were the most commonly treated (37.5% by year five). A diagnosis of osteoporosis resulted in greater treatment: 67% of participants with diagnosed osteoporosis were treated with a bisphosphonate and 87% were taking calcium and/or vitamin D (year five).

Conclusions

In this population-based study, both a diagnostic and therapeutic gap existed between knowledge and practice related to fragility fractures and osteoporosis in men aged ≥50 years.

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Acknowledgements

The Canadian Multicentre Osteoporosis Study was funded by the Canadian Institutes of Health Research (CIHR), Merck Frosst Canada Ltd., Eli Lilly Canada Inc., Novartis Pharmaceuticals Inc., The Alliance: sanofi-aventis & Procter and Gamble Pharmaceuticals Canada Inc., The Dairy Farmers of Canada, The Arthritis Society. The authors wish to acknowledge the CaMos Research Group, for its role in implementing and overseeing the project. We thank Claudie Berger and Wei Zhou for data analysis and manuscript review, and Janet Pritchard for her assistance with editing and submitting the manuscript.

Role of the sponsor

The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Author information

Authors and Affiliations

  1. Division of Geriatric Medicine, McMaster University, Hamilton Health Sciences - Chedoke Site, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada

    A. Papaioannou, C. C. Kennedy, G. Ioannidis, L. Pickard & J. D. Adachi

  2. CaMos Analysis Centre, McGill University, Montreal, QC, Canada

    Y. Gao

  3. University of Toronto, Toronto, ON, Canada

    A. M. Sawka, R. G. Josse & N. Kreiger

  4. McGill University, Montreal, QC, Canada

    D. Goltzman & A. Tenenhouse

  5. University of Saskatchewan, Saskatoon, SK, Canada

    W. P. Olszynski

  6. Laval University, Ste-Foy, QC, Canada

    K. S. Davison & J. P. Brown

  7. Dalhousie University, Halifax, NS, Canada

    S. Kaiser

  8. University of Calgary, Calgary, AB, Canada

    D. A. Hanley

  9. University of British Columbia, Vancouver, BC, Canada

    J. C. Prior

  10. Queen’s University, Kingston, ON, Canada

    T. Anastassiades

Authors
  1. A. Papaioannou
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  2. C. C. Kennedy
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  3. G. Ioannidis
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  4. Y. Gao
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  5. A. M. Sawka
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  6. D. Goltzman
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  7. A. Tenenhouse
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  8. L. Pickard
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  9. W. P. Olszynski
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  10. K. S. Davison
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  11. S. Kaiser
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  12. R. G. Josse
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  13. N. Kreiger
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  14. D. A. Hanley
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  15. J. C. Prior
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  16. J. P. Brown
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  17. T. Anastassiades
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  18. J. D. Adachi
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Consortia

CaMos Research Group

Corresponding author

Correspondence to A. Papaioannou.

Additional information

Competing interests

Alexandra Papaioannou, MD, MSc

Consulting Role: Amgen, Eli Lilly, Merck Frosst, Novartis, Proctor & Gamble, sanofi aventis Clinical Trials: Eli Lilly, Merck, Novartis, Proctor & Gamble, sanofi-aventis,

Wojciech P. Olszynski, MD, PhD

Consulting Role: Abbott Laboratories, Merck Frosst, Amgen, Novartis, Aventis, Pfizer, Boehringer Ingelheim, Procter & Gamble, Eli Lilly, Sanofi-Synthelabo, Genzyme, Schering Canada, GlaxoSmithKline, Solvay Pharma, Hoffmann-LaRoche, Wyeth, Janssen-Ortho Inc./Ortho-Biotech

STEPHANIE KAISER, MD

Consulting Role: Eli Lilly, Proctor & Gamble /Aventis, Merck, Servier, Novartis, Astra Zeneca, Abbott Advisory boards: Eli Lilly, Novartis, Servier

David A. Hanley, MD

Advisory Boards: Merck, Proctor & Gamble, Eli Lilly, Novartis, NPS Pharmaceuticals, Paladin Clinical Trials: Merck, Proctor & Gamble, Eli Lilly, Novartis, NPS Pharmaceuticals, Pfizer, Amgen, Wyeth-Ayerst, Roche

Jonathan D. Adachi, MD

Consulting Role: Amgen; Astra Zeneca, Eli Lilly; GlaxoSmithKline; Merck Frosst; Novartis; Proctor & Gamble; Roche; Sanofi Aventis; Servier Clinical Trials: Eli Lilly; GlaxoSmithKline; Merck; Novartis; Pfizer; Proctor & Gamble; sanofi-aventis; Servier; Wyeth-Ayerst

David Goltzman, MD

Consulting Role: Lilly, Novartis, Merck, sanofi-aventis, Proctor & Gamble, Servier

Robert G. Josse, MD

Advisory boards, honoraria, research grants: Lilly, Proctor & Gamble/sanofi-aventis, Merck, Novartis, Servier, GlaxoSmithKline, Amgen

Jacques P. Brown, MD

Consulting Role: Eli Lilly, Novartis, Procter & Gamble, and Sanofi-Aventis

Jerilynn C. Prior MD, Courtney C. Kennedy MSc, George Ioannidis MSc, Yongjun Gao MSc, Anna M. Sawka MD, PhD, Nancy Kreiger PhD, Shawn Davison PhD, Laura Pickard MA: No competing interests to declare.

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Papaioannou, A., Kennedy, C.C., Ioannidis, G. et al. The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19, 581–587 (2008). https://doi.org/10.1007/s00198-007-0483-0

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  • DOI: https://doi.org/10.1007/s00198-007-0483-0

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