The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study.
Fragility fracture
Observational study
Osteoporosis
Primary care
Treatment gap
Journal
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
ISSN: 1433-2965
Titre abrégé: Osteoporos Int
Pays: England
ID NLM: 9100105
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
22
03
2020
accepted:
21
07
2020
pubmed:
24
8
2020
medline:
19
3
2021
entrez:
24
8
2020
Statut:
ppublish
Résumé
This study in 8 countries across Europe found that about 75% of elderly women seen in primary care who were at high risk of osteoporosis-related fractures were not receiving appropriate medication. Lack of osteoporosis diagnosis appeared to be an important contributing factor. Treatment rates in osteoporosis are documented to be low. We wished to assess the osteoporosis treatment gap in women ≥ 70 years in routine primary care across Europe. This cross-sectional observational study in 8 European countries collected data from women 70 years or older visiting their general practitioner. The primary outcome was treatment gap: the proportion who were not receiving any osteoporosis medication among those at increased risk of fragility fracture (using history of fracture, 10-year probability of fracture above country-specific Fracture Risk Assessment Tool [FRAX] thresholds, T-score ≤ - 2.5). Median 10-year probability of fracture (without bone mineral density [BMD]) for the 3798 enrolled patients was 7.2% (hip) and 16.6% (major osteoporotic). Overall, 2077 women (55%) met one or more definitions for increased risk of fragility fracture: 1200 had a prior fracture, 1814 exceeded the FRAX threshold, and 318 had a T-score ≤ - 2.5 (only 944 received a dual-energy x-ray absorptiometry [DXA] scan). In those at increased fracture risk, the median 10-year probability of hip and major osteoporotic fracture was 11.2% and 22.8%, vs 4.1% and 11.5% in those deemed not at risk. An osteoporosis diagnosis was recorded in 804 patients (21.2%); most (79.7%) of these were at increased fracture risk. The treatment gap was 74.6%, varying from 53% in Ireland to 91% in Germany. Patients with an osteoporosis diagnosis were found to have a lower treatment gap than those without a diagnosis, with an absolute reduction of 63%. There is a large treatment gap in women aged ≥ 70 years at increased risk of fragility fracture in routine primary care across Europe. The gap appears to be related to a low rate of osteoporosis diagnosis.
Identifiants
pubmed: 32829471
doi: 10.1007/s00198-020-05557-z
pii: 10.1007/s00198-020-05557-z
pmc: PMC7838133
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
251-259Subventions
Organisme : Medical Research Council
ID : MR/P020941/1
Pays : United Kingdom
Références
Ström O, Borgström F, Kanis JA et al (2011) Osteoporosis: burden, health care provision and opportunities in the EU. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6:59–155
doi: 10.1007/s11657-011-0060-1
Kanis JA, Cooper C, Rizzoli R et al (2017) Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int 28:2023–2034
doi: 10.1007/s00198-017-4009-0
Hernlund E, Svedbom A, Ivergård M et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136
doi: 10.1007/s11657-013-0136-1
Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393:364–376
doi: 10.1016/S0140-6736(18)32112-3
Chenot R, Scheidt-Nave C, Gabler S, Kochen MM, Himmel W (2007) German primary care doctors’ awareness of osteoporosis and knowledge of national guidelines. Exp Clin Endocrinol Diabetes 115:584–589
doi: 10.1055/s-2007-981454
Lespessailles E, Cotté F-E, Roux C, Fardellone P, Mercier F, Gaudin A-F (2009) Prevalence and features of osteoporosis in the French general population: the Instant study. Joint Bone Spine 76:394e400
doi: 10.1016/j.jbspin.2008.10.008
Sahota O, Worley A, Hosking J (2000) An audit of current clinical practice in the management of osteoporosis in Nottingham. Journal of Public Health Medicine 22:466–472
doi: 10.1093/pubmed/22.4.466
Judge A, Javaid MK, Leal J, et al (2016) Chapter 7: Primary care and hospital care costs for hip fracture patients. In: Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England. NIHR Journals Library, Southampton, UK. Health Services and Delivery Research;4.28. https://www.ncbi.nlm.nih.gov/books/NBK385602/ . Accessed Sept 20, 2019
Compston J, Cooper A, Cooper C et al (2017) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 12:43. https://doi.org/10.1007/s11657-017-0324-5 Accessed 17 Sept 2019
doi: 10.1007/s11657-017-0324-5
pubmed: 28425085
pmcid: 5397452
Marsh D, Åkesson K, Beaton DE (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22:2051–2065
doi: 10.1007/s00198-011-1642-x
Kanis JA, Svedbom A, Harvey N et al (2014) The osteoporosis treatment gap. J Bone Miner Res 29:1926–1928
doi: 10.1002/jbmr.2301
McCloskey E, Rathi J, Heijmans S et al (2019) Osteoporosis (OP) diagnosis and treatment of women aged ≥70 years in primary care: results from a large European cross-sectional study. World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, Paris, France, April 4–7, (poster P997)
Díez-Pérez A, Hooven FH, Adachi JD et al (2011) Regional differences in treatment for osteoporosis. The Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone 49:493–498
doi: 10.1016/j.bone.2011.05.007
Dachverband Osteologie. DVO-LEITLINIE 2017 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern (German). https://www.dv-osteologie.org/uploads/Leitlinie%202017/DVO%20Leitlinie_Kitteltaschenversion_gesamt.pdf . Accessed 13 Mar 2020.
Briot K, Roux C, Thomas T, Blain H et al (2018) 2018 update of French recommendations on the management of postmenopausal osteoporosis. Joint Bone Spine 85:519–530
doi: 10.1016/j.jbspin.2018.02.009
Kanis JA, Cooper C, Rizzoli R et al (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis Int 30:3–44
doi: 10.1007/s00198-018-4704-5
Shepstone L, Lenaghan E, Cooper C et al (2018) for SCOOP Study Team. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet 391:741–747
doi: 10.1016/S0140-6736(17)32640-5
Dennison EM, Compston JE, Flahive J et al (2012) Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone 50:1288–1293
doi: 10.1016/j.bone.2012.02.639
Raherison C, Girodet P-O (2009) Epidemiology of COPD. Eur Respir Rev 18:213–221
doi: 10.1183/09059180.00003609
Lorentzon M, Nilsson AG, Johansson H, Kanis JA, Mellström D, Sundh D (2019) Extensive undertreatment of osteoporosis in older Swedish women. Osteoporosis International 30:1297–1305
doi: 10.1007/s00198-019-04872-4
Hiligsmann M, Cornelissen D, Vrijens B et al (2019) Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF). Osteoporos Int 30:2155–2165
doi: 10.1007/s00198-019-05104-5
Cipriani C, Pepe J, Minisola S, Lewiecki EM (2018) Adverse effects of media reports on the treatment of osteoporosis. J Endocrinol Invest 41:1359–1364
doi: 10.1007/s40618-018-0898-9
Wuab CH, Tuc ST, Chang YF et al (2018) Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Bone 111:92–110
doi: 10.1016/j.bone.2018.03.018
Rubin KH, Rothmann MJ, Holmberg T et al (2018) Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study. Osteoporos Int 29:567–578
doi: 10.1007/s00198-017-4326-3
Merlijn T, Swart KM, van Schoor NM et al (2019) The effect of a screening and treatment program for the prevention of fractures in older women: a randomized pragmatic trial. J Bone Miner Res 34:1993–2000
doi: 10.1002/jbmr.3815
Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM (2020) Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporos Int 31:251–257
doi: 10.1007/s00198-019-05226-w
Chotiyarnwong P, Harvey NC, Johansson H et al (2019) Temporal changes in access to FRAX(R) in Thailand between 2010 and 2018. Arch Osteoporos 14:66
doi: 10.1007/s11657-019-0613-2