Summary

In many countries, osteoporosis is predominantly managed by primary care physicians; however, management after a fragility fracture has not been widely investigated. We describe osteoporosis care gaps in a real-world patient cohort. Our findings help inform initiatives to identify and overcome obstacles to effective management of patients after fragility fracture.

Purpose

A fragility fracture is a major risk factor for subsequent fracture in adults aged ≥ 50 years. This retrospective observational study aimed to characterize post-fracture management in Canadian primary care.

Methods

A total of 778 patients with an index fragility fracture (low-trauma, excluding small bones) occurring between 2014 and 2016 were identified from medical records at 76 primary care centers in Canada, with follow-up until January 2018.

Results

Of 778 patients (80.5% female, median age [IQR] 73 [64–80]), 215 were on osteoporosis treatment and 269 had osteoporosis diagnosis recorded prior to their index fracture. The median follow-up was 363 (IQR 91–808) days. Of patients not on osteoporosis treatment at their index fracture, 60.2% (n = 339/563) remained untreated after their index fracture and 62.2% (n = 23/37) continued untreated after their subsequent fracture. After their index fracture, fracture risk assessment (FRAX or CAROC) was not performed in 83.2% (n = 647/778) of patients, and 59.9% (n = 466/778) of patients did not receive bone mineral density testing. Of patients without osteoporosis diagnosis recorded prior to their index date, 61.3% (n = 300/489) remained undiagnosed after their index fracture. At least one subsequent fracture occurred in 11.5% (n = 86/778) of patients.

Conclusion

In the primary care setting, fragility fracture infrequently resulted in osteoporosis treatment or fracture risk assessment, even after multiple fragility fractures. These results suggest a fragility fracture is not recognized as a major risk factor for subsequent fracture and its occurrence does not prompt primary care physicians to intervene. These data urge initiatives to identify and overcome obstacles to primary care physicians’ effective management of patients after fragility fractures.

中文翻译：

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初级保健中脆性骨折后骨质疏松治疗的回顾性观察研究

概括

在许多国家，骨质疏松症主要由初级保健医生治疗；然而，脆性骨折后的治疗尚未得到广泛研究。我们描述了现实世界患者队列中骨质疏松症护理的差距。我们的研究结果有助于为识别和克服脆性骨折后患者有效管理的障碍提供信息。

目的

脆性骨折是 50 岁以上成人后续骨折的主要危险因素。这项回顾性观察研究旨在描述加拿大初级保健中骨折后管理的特征。

方法

根据加拿大 76 个初级保健中心的医疗记录，共识别出 2014 年至 2016 年间发生的 778 名指数脆性骨折（低创伤，不包括小骨）患者，并随访至 2018 年 1 月。

结果

在 778 名患者中（80.5% 为女性，中位年龄 [IQR] 73 [64–80]），215 名患者正在接受骨质疏松症治疗，269 名患者在指数骨折前记录有骨质疏松症诊断。中位随访时间为 363 (IQR 91-808) 天。在食指骨折时未接受骨质疏松症治疗的患者中，60.2% ( n  = 339/563) 在食指骨折后仍未接受治疗，62.2% ( n  = 23/37) 在随后的骨折后仍未接受治疗。指数骨折后，83.2% ( n  = 647/778) 的患者未进行骨折风险评估（FRAX 或 CAROC） ，59.9% ( n  = 466/778) 的患者未接受骨密度测试。在索引日期之前未记录骨质疏松症诊断的患者中，61.3% ( n  = 300/489) 在索引骨折后仍未得到诊断。11.5% ( n  = 86/778) 的患者至少发生一次后续骨折。

结论

在初级保健机构中，即使发生多次脆性骨折，脆性骨折也很少导致骨质疏松症治疗或骨折风险评估。这些结果表明，脆性骨折不被认为是后续骨折的主要危险因素，其发生也不会促使初级保健医生进行干预。这些数据敦促采取行动，找出并克服初级保健医生对脆性骨折后患者进行有效管理的障碍。