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Significant Gaps Remain for Fracture Risk Calculation and Osteoporosis Management Within Primary Care


Evidence published in a recent Canadian study, Use of an electronic medical record dashboard to identify gaps in osteoporosis care, found that despite access to Canadian Osteoporosis Clinical Practice Guidelines (CPGs) and fracture risk calculators, significant gaps remain in fracture risk calculation and osteoporosis management within the primary care setting. Additional strategies are needed to address this critical clinical gap among family physicians.

Osteoporosis is a manageable chronic disease and the risk of osteoporotic fractures can be reduced with treatment. However, studies have shown a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis. The CPGs provide recommendations for the assessment and management of osteoporosis and specify that osteoporosis management should be guided by assessing a patient’s absolute risk of osteoporosis-related fractures. Yet, as highlighted in a recent report by the Public Health Agency of Canada, fewer than 20% of Canadians experiencing an osteoporotic-related fracture received an osteoporosis diagnosis, underwent a bone mineral density test or received a prescription for an osteoporosis-related medication within one year of the fracture.

Using an electronic medical record (EMR)-based dashboard called the “ADVANTAGE OP EMR” tool, 84 physicians located across Canada shared their practice activities related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk.

Key results of the study included the following:

  • Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture.
  • Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed.
  • For patients with BMD completed, fracture risk was calculated in only 29%.
  • Of those with fracture risk calculated, 19% were at high risk, of whom 37% were not treated with osteoporosis medications.

According to a different study of 1054 family physicians in Ontario, 77% of Ontario family physicians identified the lack of EMR tools as a significant barrier to implementing the osteoporosis clinical practice guidelines.

Osteoporosis is a condition that causes bones to become thin and porous, decreasing bone strength and leading to increased risk of breaking a bone. At least one in three women and one in five men will suffer a broken bone from osteoporosis during their lifetime. Broken bones from osteoporosis are more common than heart attack, stroke and breast cancer combined. One in three people who break a hip will re-break within one year, and over one in two hip fracture patients will suffer another bone break within five years.

In 2020, the Public Health Agency of Canada recognized osteoporosis as a major public health concern in Canada and worldwide. The main public health challenge lies in the fractures associated with the disease. Such fractures are associated with significant morbidity, mortality and costs. Despite interventions that have been shown to substantially reduce the risk of osteoporotic fractures, most individuals at high risk of fracture do not undergo appropriate screening or treatment.

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