Postfracture care for older women: gaps between optimal care and actual care.

OBJECTIVE

To investigate rates of assessment and treatment of osteoporosis among older women during the year after they have had fractures.

DESIGN

Observational, historical, population-based cohort study.

SETTING

Manitoba, which maintains a comprehensive population-based repository of health care services provided and has a publicly funded health care system.

PARTICIPANTS

Women 50 years old and older who had suffered fractures between 1997 and 2002. These women were chosen from among approximately 175,000 women of this age in Manitoba.

METHODS

We examined each woman's annual medical record between April 1, 1997, and March 31, 2002, to find any International Classification of Diseases fracture codes that have been consistently associated with osteoporosis. We looked for postfracture care during the first 12 months after fractures: bone mineral density (BMD) testing or treated with osteoporosis pharmacotherapy. Analysis was stratified by type of fracture: designated type 1 fractures (spine or hip) and type 2 fractures (not spine or hip).

MAIN OUTCOME MEASURES

Use of BMD testing or osteoporosis pharmacotherapy during the first 12 months following fractures.

RESULTS

For type 1 fractures, BMD assessment during the first year after fracture increased from 2.6% in 1997-1998 to 4.6% in 2001-2002 (P for trend .0004). Rates of therapy with osteoporosis medication increased from 4.9% in 1997-1998 to 17.6% in 2001-2002 (P for trend < .0001). Results were similar for type 2 fractures. In the final year of the study, only 20.5% of women with either type of fracture underwent any identifiable intervention (BMD assessment or osteoporosis pharmacotherapy). The intervention rate was substantially higher among women 50 to 64 years old (26.4%) than among those 75 years old or older (17.9%, P for trend < .0001).

CONCLUSION

Women at highest risk of future fractures are assessed infrequently for osteoporosis with BMD testing and given pharmacotherapy to prevent future fractures just as infrequently. This gap in care was particularly striking for BMD testing despite the fact that testing is free in Manitoba's publicly funded system. Data from this study could be educational for physicians treating osteoporosis and should encourage them to improve their practice patterns and optimize patient care.