Management of osteoporosis in primary care before and after the result of densitometry: treatments in real practice versus the recommended by guidelines. CANAL study.

OBJECTIVES

To analyze the requirements for osteoporosis (OP) treatment of primary care physicians (PCP), before and after knowing the result of a bone densitometry (DXA).

MATERIAL AND METHODS

We studied 50 years older women from two Spanish health areas (Canary Islands and Alicante). The FRAX risk factors were collected and we reviewed the requirements for OP treatment before DXA and in the subsequent months (bisphosphonates, strontium, raloxifene/bazedoxifene, estrogens, parathyroid hormone). To evaluate the appropriateness of treatment we used published guidelines. A high risk for hip fracture was considered if FRAX ≥ 3% or the patient had a history of fragility fracture

RESULTS

We included 339 women (mean age: 63 years). Before DXA, 14% of Canarias and 58% of Alicante were receiving treatment. Thirty seven percent of treated patients and 26% of the untreated patients had a high fracture risk before DXA. The average FRAX for a high risk of fracture and hip fracture was 5.6% and 2%, respectively. After DXA, the percentage of treated patients rose from 35 to 39%: increasing from 14 to 28% in the Canary Islands and decreasing from 58 to 51% in Alicante. Overall, treatment was received by 64% of patients with OP, 38% of patients with osteopenia and 15% of those with normal DXA. When the OP treatment guidelines were applied, we found that 7% needed treatment according to the most restrictive guidelines and 43% according to the most flexible guidelines.

CONCLUSIONS

There is great variability in treatment for OP prescribed before after DXA between GP. A broad consensus guideline between different specialties is required to optimize clinical practice.