Osteoporosis care gap: researchers find majority of patients not receiving recommended preventative treatment

A new study has found that two thirds of seniors who suffer an osteoporotic fracture of the hip, pelvis, or spine in Ontario are not getting medications that they need to prevent future fractures.

The study, led by researchers at Sunnybrook Research Institute, looked at patients 66 years or older who experienced a fragility fracture of the hip, vertebrae or pelvis and were admitted to hospital between January 2017 and December 2021. Using data from the Ontario Ministry of Health, the researchers analyzed how many of these patients later filled a prescription for an anti-osteoporosis medication. They found that fewer than one third of patients received anti-osteoporosis medications in the year after discharge for their fracture.

“Our findings are reflective of a care gap in Ontario, but also in other regions,” says Dr. William Silverstein, lead author of the study and a General Internal Medicine physician and associate scientist at Sunnybrook.” Despite system-wide efforts and clear clinical guidelines on the effectiveness of these medications to prevent future fractures, many patients are not receiving these treatments and go on to have a repeat fracture, which can have a significant impact on quality of life.”

In Canada, more than 2.3 million Canadians are living with osteoporosis and over 80 per cent of fractures in people over 50 are caused by the disease. These injuries, called fragility fractures, are from low trauma events like a fall from standing height, and are diagnostic of osteoporosis or weakening of the bone.

“We regularly see the impact these fractures can have on mobility and quality of life,” says co-author Dr. Jonathan Zipursky, General Internal Medicine physician and scientist at Sunnybrook. “Our hope is we can intervene at the point of that initial fracture, if not before, to prevent future injuries that could put patients at risk of morbidity or mortality.”

Sunnybrook recently implemented a new care pathway that standardizes the medical assessment of inpatients with osteoporotic hip/vertebral fractures to improve prescribing rates. The medical directive enables pharmacists in orthopaedic surgery to prescribe an intravenous anti-osteoporosis treatment (whose effect lasts one year). The program, which was recognized as a Leading Practice by Accreditation Canada, has significantly increased anti-osteoporosis treatment at Sunnybrook.

“We know surgery, hospitalization and rehab can be a busy and stressful time for patients and families,” says Dr. Silverstein. “Providing preventative treatment while patients are already in hospital is one way we’re working to prevent the costly and life-altering risks of refracture.”