Osteoporotic fractures are associated with significant morbidity and mortality. The current study used explicit medical record review to (i) determine the number of patients with osteoporotic fractures who were not investigated or treated for osteoporosis by their primary care physician, and (ii) identify factors that contribute to the ongoing gap in osteoporosis care.

Three major General Practices in metropolitan Sydney provided a complete list of imaging studies performed on all of their patients from 1/10/2012 to 30/9/2014, resulting in a total of 6,393 individual imaging events. After exclusion of non-skeletal imaging procedures, 3,715 studies remained of which 1,860 had been performed in people > 55 years of age. Demographics, prior fractures, testing for vitamin D/bone mineral density, and initiation of osteoporosis pharmacotherapy were recorded for all patients 55 years or older who had a documented minimal trauma fracture (MTF). Main outcome measures were the number of patients who did not undergo (i) a bone density scan, (ii) vitamin D measurement, and/ or (iii) initiation of osteoporosis pharmacotherapy.

Of the 87 patients (69% female; mean age 71.7 years) with prevalent MTF, 55 (63%) were not referred for a bone density scan. Vitamin D levels were not measured in 36 patients (41%) and 55 patients (63%) did not receive specific osteoporosis pharmacotherapy. Failure to investigate was highly predictive of failure to treat (p<0.001).  The presence of major osteoporotic risk factors was not associated with the likelihood of investigation or treatment, indicating that a major barrier to effective osteoporosis management was a lack of knowledge.

We conclude that management of patients with osteoporotic fractures in primary care is poor. Systems aimed at improving the identification and treatment of patients with osteoporotic fractures in this setting is required in order to close the osteoporosis care gap.