Osteoporosis Care Gap

Abstract

Osteoporosis and its related fractures pose a major public health concern and a considerable economic burden on health care systems. There are recognized gaps, not only in care between best practice and actual care delivery as it relates to osteoporosis screening access, but also from knowledge to practice as men and women at risk of osteoporosis and fragility fractures are not engaging in adequate preventive health behaviours. A series of three studies were conducted and emphasized primary and secondary prevention of osteoporosis in effort to reduce the care gap. The purpose of Study 1 was to conduct a systematic review to identify common validated clinical risk factor assessment tools in predicting low BMD in postmenopausal women and identify which tool demonstrated the best discriminative performance. A comprehensive literature review of published data in multiple databases was performed based on standardized inclusion and exclusion criteria. Based on 22 primary articles, two independent reviewers identified six risk factor assessment tools. The OST was the simplest tool to determine postmenopausal women at increased risk of osteoporosis who would benefit from DXA screening, while still maintaining acceptable discriminatory abilities. Results of this study were used to inform Study 2. The purpose of Study 2 was to evaluate the accuracy of calcaneal QUS and OST in identifying men and women over 50 years of age with osteoporosis as defined by DXA, and to establish optimal cut-offs to determine risk. This study (N = 202, Mage = 59.7 years) assessed BMD of the lumbar spine and femoral neck using DXA and subsequent calcaneal QUS and OST assessment. Pearson’s product correlation coefficients between QUS and DXA parameters were calculated. ROC analyses were performed and optimal thresholds for QUS were defined based on sensitivity, specificity, and likelihood ratio analysis. Results showed QUS at the femoral neck in women consistently out-performed QUS at the lumbar spine and OST in men and women. QUS SI cut-off values that fall between 65 and 78 would warrant DXA screening, with a cutoff < 65 indicating high likelihood of osteoporosis. The purpose of Study 3 was to determine the influence of DXA screening combined with theory-based osteoporosis education versus usual care (DXA screening alone) on change in men and women’s health behaviours, specifically calcium and vitamin D intake, physical activity, and drug treatment initiation. A 6-month RCT was conducted in 203 men and women (Mage = 59.7 years) referred by an HCP to undergo DXA screening for the first time. Participants were randomly assigned to an intervention group (n = 102) or usual care group (n = 101) and completed a series of questionnaires. The intervention group received osteoporosis education, using the Health Belief Model as a theoretical framework. Results showed the intervention increased calcium and vitamin D intake and physical activity compared to DXA screening alone. Multivariate logistic regression analyses showed the intervention was an independent predictor of calcium intake, and DXA screening results indicating low BMD independently predicted drug treatment initiation. Overall, the series of studies provided valuable insight for practical solutions regarding improved detection of osteoporosis and informing health promotion programs for prevention and management of the disease. It is evident there is an overall need for studies evaluating osteoporosis detection, prevention, and management in older men.