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Osteoporos Int. 2008 Apr;19(4):581-7. Epub 2007 Oct 9.

The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study.

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Division of Geriatric Medicine, McMaster University, Hamilton Health Sciences-Chedoke Site, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada.


We examined osteoporosis diagnosis/treatment in 2,187 community dwelling men age 50+. After five years in the study, 90% of men with fragility fractures remained undiagnosed and untreated for osteoporosis. The need to treat fragility fractures is well established in guidelines, and these numbers represent an important care gap.


Whether physicians in the community are recognizing and appropriately treating osteoporosis and fragility fractures in men remains unknown. We examined the rate of diagnosis and treatment in community dwelling men participating in the Canadian Multicentre Osteoporosis Study (CaMos).


Between February 1996 and September 2002, 2,187 participants were recruited from nine sites across Canada and prospectively followed. Information on osteoporosis diagnosis, fractures, medications were collected annually by a detailed questionnaire. DXA examination of lumbar spine (L1-4) and hip were conducted at baseline and year five.


Diagnosis and treatment in men with clinical fragility fractures was low: at baseline and year five only 2.3% and 10.3% of men with a clinical fracture reported an osteoporosis diagnosis, respectively. At year five, 90% of men with a clinical fragility fracture were untreated. Hip fractures were the most commonly treated (37.5% by year five). A diagnosis of osteoporosis resulted in greater treatment: 67% of participants with diagnosed osteoporosis were treated with a bisphosphonate and 87% were taking calcium and/or vitamin D (year five).


In this population-based study, both a diagnostic and therapeutic gap existed between knowledge and practice related to fragility fractures and osteoporosis in men aged >or=50 years.

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Conflict of interest statement

Alexandra Papaioannou, MD, MSc Consulting Role: Amgen, Eli Lilly, Merck Frosst, Novartis, Proctor & Gamble, sanofi aventis Clinical Trials: Eli Lilly, Merck, Novartis, Proctor & Gamble, sanofi-aventis, Wojciech P. Olszynski, MD, PhD Consulting Role: Abbott Laboratories, Merck Frosst, Amgen, Novartis, Aventis, Pfizer, Boehringer Ingelheim, Procter & Gamble, Eli Lilly, Sanofi-Synthelabo, Genzyme, Schering Canada, GlaxoSmithKline, Solvay Pharma, Hoffmann-LaRoche, Wyeth, Janssen-Ortho Inc./Ortho-Biotech STEPHANIE KAISER, MD Consulting Role: Eli Lilly, Proctor & Gamble/Aventis, Merck, Servier, Novartis, Astra Zeneca, Abbott Advisory boards: Eli Lilly, Novartis, Servier David A. Hanley, MD Advisory Boards: Merck, Proctor & Gamble, Eli Lilly, Novartis, NPS Pharmaceuticals, Paladin Clinical Trials: Merck, Proctor & Gamble, Eli Lilly, Novartis, NPS Pharmaceuticals, Pfizer, Amgen, Wyeth-Ayerst, Roche Jonathan D. Adachi, MD Consulting Role: Amgen; Astra Zeneca, Eli Lilly; GlaxoSmithKline; Merck Frosst; Novartis; Proctor & Gamble; Roche; Sanofi Aventis; Servier Clinical Trials: Eli Lilly; GlaxoSmithKline; Merck; Novartis; Pfizer; Proctor & Gamble; sanofi-aventis; Servier; Wyeth-Ayerst David Goltzman, MD Consulting Role: Lilly, Novartis, Merck, sanofi-aventis, Proctor & Gamble, Servier Robert G. Josse, MD Advisory boards, honoraria, research grants: Lilly, Proctor & Gamble/sanofi-aventis, Merck, Novartis, Servier, GlaxoSmithKline, Amgen Jacques P. Brown, MD Consulting Role: Eli Lilly, Novartis, Procter & Gamble, and Sanofi-Aventis Jerilynn C. Prior MD, Courtney C. Kennedy MSc, George Ioannidis MSc, Yongjun Gao MSc, Anna M. Sawka MD, PhD, Nancy Kreiger PhD, Shawn Davison PhD, Laura Pickard MA: No competing interests to declare.

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