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Osteoporos Int. 2011 Mar;22(3):789-96. doi: 10.1007/s00198-010-1359-2. Epub 2010 Aug 4.

Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study.

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Departments of Epidemiology and Medicine, Hamilton Health Sciences-Chedoke Site, McMaster University, 1200 Main Street West, Hamilton, ON L8N3Z5, Canada.


Canadian women over 50 years old were studied over a 10-year period to see if those who sustained a fracture (caused by minimal trauma) were receiving the recommended osteoporosis therapy. We found that approximately half of these women were not being treated, indicating a significant care gap in osteoporosis treatment.


Prevalent fragility fracture strongly predicts future fracture. Previous studies have indicated that women with fragility fractures are not receiving the indicated treatment. We aimed to describe post fracture care in Canadian women using a large, population-based prospective cohort that began in 1995-1997.


We followed 5,566 women over 50 years of age from across Canada over a period of 10 years in the Canadian Multicentre Osteoporosis Study. Information on medication use and incident clinical fragility fractures was obtained during a yearly questionnaire or interview and fractures were confirmed by radiographic/medical reports.


Over the 10-year study period, 42-56% of women with yearly incident clinical fragility fractures were not treated with an osteoporosis medication. During year 1 of the study, 22% of the women who had experienced a fragility fracture were on treatment with a bisphosphonate and 26% were on hormone therapy (HT). We were not able to differentiate HT use for menopause symptoms vs osteoporosis. Use of bisphosphonate therapy increased over time; odds ratio (OR) for use at year 10 compared to use at year 1 was 3.65 (95% confidence interval (CI) 1.83-7.26). In contrast, HT use declined, with an OR of 0.07 (95%CI 0.02-0.24) at year 10 compared to year 1 of the study.


In a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures. Although bisphosphonate therapy usage improved over time, a substantial gap remains.

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Conflict of interest statement

Dr. Fraser, Dr. Ioannidis, Ms. Pickard, Dr. Prior, Dr. Olszynski, Dr. Anastassiades, Dr. Jamal, Dr. Josse, and Dr. Goltzman have no conflicts of interest to declare for this manuscript. Dr. Adachi has been a consultant/speaker for: Amgen, Astra Zeneca, Eli Lilly, GSK, Merck, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, Sanofi Aventis, Servier, Wyeth and Bristol-Myers Squibb; and has conducted clinical trials for: Amgen, Eli Lilly, GSK, Merck, Novartis, Pfizer, Procter & Gamble, Sanofi Aventis, Roche, Wyeth, and Bristol-Myers Squibb. Dr. Kaiser has been on the advisory board for: Amgen, Novartis, Eli Lilly, Bristol-Myers Squibb, and Astra Zeneca; and speakers bureau for: Amgen, Novartis, Procter & Gamble/Sanofi Aventis, Merck Frosst, and Eli Lilly. Dr. Jacques Brown has received consulting fees or other remuneration from: Abbott, Amgen, Eli Lilly, Novartis, Merck, and Warner Chilcott; received research grants from: Abbott, Amgen, Bristol-Myers-Squibb, Eli Lilly, Pfizer, and Roche; and been on the speakers bureau for: Eli Lilly, Amgen, Novartis, Merck, and Warner Chilcott. Dr. Hanley has been on the advisory board for: Amgen, Merck Frosst, Warner-Chilcott, Novartis, and Eli Lilly; performed clinical trials for: Amgen, Merck Frosst, Procter & Gamble/Sanofi Aventis, Novartis, NPS Pharmaceuticals, Eli Lilly, Pfizer, and Wyeth-Ayerst; and received speaking honoraria from: Amgen, Merck Frosst, Procter & Gamble/Sanofi Aventis, Novartis, NPS Pharmaceuticals, Eli Lilly, Pfizer, and Wyeth-Ayerst. Dr. Papaioannou has been a consultant/speaker for: Amgen, Aventis, Eli Lilly, Merck Frosst, Novartis, Procter & Gamble, Servier, and Wyeth-Ayerst; conducted clinical trials for: Eli Lilly, Merck Frosst, Novartis, Procter & Gamble, and Sanofi-Aventis; and received unrestricted grants from: Amgen, Eli Lilly, Merck Frosst, Procter & Gamble, and Sanofi-Aventis.

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