The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

Osteoporos Int. 2021 Feb;32(2):251-259. doi: 10.1007/s00198-020-05557-z. Epub 2020 Aug 23.


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 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%.

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.

Publication types

  • Observational Study

MeSH terms

  • Absorptiometry, Photon
  • Aged
  • Bone Density
  • Cross-Sectional Studies
  • Europe / epidemiology
  • Female
  • Germany
  • Humans
  • Osteoporosis* / drug therapy
  • Osteoporosis* / epidemiology
  • Osteoporotic Fractures* / epidemiology
  • Osteoporotic Fractures* / etiology
  • Osteoporotic Fractures* / prevention & control
  • Primary Health Care
  • Risk Assessment
  • Risk Factors