The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional
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ORIGINAL ARTICLE
The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study E. McCloskey 1 & J. Rathi 2 & S. Heijmans 3 & M. Blagden 4 & B. Cortet 5 & E. Czerwinski 6 & P. Hadji 7,8 & J. Payer 9 & K. Palmer 10 & R. Stad 11 & J. O’Kelly 10 & S. Papapoulos 12 Received: 22 March 2020 / Accepted: 21 July 2020 # The Author(s) 2020
Abstract Summary 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. Introduction 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. Methods 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). Results 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 dualenergy 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%. Conclusions 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. Keywords Fragility fracture . Observational study . Osteoporosis . Primary care . Treatment gap Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00198-020-05557-z) contains supplementary material, which is available to authorized users. * E. McCloskey [email protected] 1
Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
2
Carrig Medical Centre, Cork, Ireland
3
ResearchLink, Linkebeek, Belgium
4
Ashgate Medical Practice, Chesterfield, UK
5
Department of Rheumatology and EA 4
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