The care gap in diagnosis and treatment of women with a fragility fracture

Osteoporos Int. 2008 Jan;19(1):79-86. doi: 10.1007/s00198-007-0426-9. Epub 2007 Jul 20.


In women aged 50 years or more who experienced a fracture, 81% suffered a fragility fracture. Six to eight months after fragility fracture, 79% had either not been investigated for osteoporosis or prescribed anti-fracture therapy. Despite fragility fractures being common in this population osteoporosis is under-diagnosed and under-treated.

Introduction: The objective of this study was to evaluate the diagnostic and treatment rates for osteoporosis six months following fragility fracture.

Methods: This prospective cohort study was set in the general community from the Province of Quebec, Canada. Women at least 50 years of age who suffered a fracture were recruited during their initial visit to the hospital and had their fracture type classified as either fragility or traumatic. Six-to-eight months after fragility fracture, women were again contacted to evaluate the diagnostic and treatment rates of osteoporosis.

Results: Of the 2,075 women recruited over a 25 month period 1,688 (81%) sustained a fragility fracture and 387 (19%) sustained a traumatic fracture. Nine hundred and three participants with a fragility fracture were again contacted six-to-eight months after fracture. For the 739 women not on treatment on the recruitment day, only 15.4% initiated pharmacological therapy in the six-to-eight-month period following fracture and 79.0% had either not been investigated for osteoporosis or prescribed anti-fracture treatment.

Conclusions: The proportion of fragility fractures to total fractures is higher than previously reported. Despite the availability of diagnostic modalities, effective treatments, and adequate health care assessments, there is a substantial care gap in the management of osteoporosis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Continuity of Patient Care
  • Episode of Care
  • Female
  • Fractures, Bone / diagnosis*
  • Fractures, Bone / epidemiology
  • Fractures, Bone / therapy
  • Fractures, Spontaneous / diagnosis*
  • Fractures, Spontaneous / epidemiology
  • Fractures, Spontaneous / therapy
  • Humans
  • Middle Aged
  • Osteoporosis / diagnosis*
  • Osteoporosis / epidemiology
  • Osteoporosis / therapy
  • Prospective Studies
  • Quebec / epidemiology