The osteoporosis diagnosis and treatment gaps among Iranian women aged 50 years and older

Shokouh Shahrousvand; Afshin Ostovar; Noushin Fahimfar; Kazem Khalagi; Elahe Hesari; Mohammad Javad Mansourzadeh; Mohammad Ali Mansournia; Mahnaz Sanjari

doi:10.1007/s40200-026-01866-y

The osteoporosis diagnosis and treatment gaps among Iranian women aged 50 years and older

J Diabetes Metab Disord. 2026 Apr 15;25(1):125. doi: 10.1007/s40200-026-01866-y. eCollection 2026 Jun.

Authors

Shokouh Shahrousvand¹, Afshin Ostovar², Noushin Fahimfar², Kazem Khalagi², Elahe Hesari², Mohammad Javad Mansourzadeh³, Mohammad Ali Mansournia¹, Mahnaz Sanjari²

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical, Tehran, Iran.
² Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
³ Prevention of Metabolic Disorders Research Center, Research Institute for Metabolic and Obesity Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

PMID: 42005855
PMCID: PMC13083676 (available on 2027-04-15)
DOI: 10.1007/s40200-026-01866-y

Abstract

Background: Despite the availability of diagnostic tools and effective treatments for osteoporosis (OP), many women do not receive adequate care. This study seeks to explore the diagnosis and treatment gaps for OP among postmenopausal women.

Methods: This cross-sectional study was conducted among Iranian women aged 50 and older selected through simple random sampling. The dependent variables were diagnosis gap and treatment gap of osteoporosis. Covariates included demographic, socioeconomic, clinical, and FRAX-related factors. After FRAX screening, participants completed a structured questionnaire. Multiple logistic regression was performed, and model selection was conducted using a backward stepwise method. Model performance was assessed using goodness-of-fit tests and AUC. Analyses were performed in Stata 14.

Results: A total of 998 women (mean age 64.6 ± 10.4 years) were included in this study. Of these, 346/998 (34.67%) were classified as being at high risk of fragility fractures based on FRAX. Among the 346 high-risk women, the osteoporosis diagnosis gap was 237/346 (68.49%), and the overall treatment gap was 248/346 (71.67%). Of 109 women diagnosed with osteoporosis and considered at high risk for fragility fractures, 11/109 (10.09%) remained untreated. Elementary education (OR = 4.80, 95% CI: 1.65-13.99, P = 0.004) and awareness of osteoporosis and its complications (OR = 6.03, 95% CI: 3.38-10.73, P < 0.001) were associated with higher odds of osteoporosis diagnosis, whereas rural residence (OR = 0.52, 95% CI: 0.30-0.91, P = 0.022) was associated with lower odds of being undiagnosed, indicating a protective effect against the diagnosis gap. No other variables, including age, BMI, and comorbidities, were significant. No predictors were associated with the treatment gap. The model showed good fit (AUC = 0.78, Hosmer-Lemeshow P = 0.45) and no multicollinearity was detected.

Conclusions: Significant gaps exist in the diagnosis and treatment of osteoporosis among Iranian women aged 50 years and older, with diagnosis and treatment gaps of 68.49% and 71.67%, respectively. Addressing these gaps requires strategies to increase patient and provider awareness, enhance primary care screening, facilitate BMD referrals, and reduce barriers to care, particularly in rural areas.

Keywords: Diagnosis gap; Iran; Osteoporosis; Treatment gap; Women.

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