November 3rd, 2021

// Significant Gaps Remain for Fracture Risk Calculation and Osteoporosis Management Within Primary Care

Significant Gaps Remain for Fracture Risk Calculation and Osteoporosis Management Within Primary Care

MISSISSAUGA, ON, Nov. 3, 2021 /CNW/ - Evidence published in a recent Canadian study,  Use of an electronic medical record dashboard to identify gaps in osteoporosis care, found that despite access to Canadian Osteoporosis Clinical Practice Guidelines (CPGs) and fracture risk calculators, significant gaps remain in fracture risk calculation and osteoporosis management within the primary care setting. Additional strategies are needed to address this critical clinical gap among family physicians. 

Osteoporosis is a manageable chronic disease and the risk of osteoporotic fractures can be reduced with treatment.iHowever, osteoporosis remains largely undiagnosed and untreated.ii,iii The CPGs provide recommendations for the assessment, prevention, and management of osteoporosis and specify that osteoporosis management should be guided by assessing a patient's absolute risk of fractures. Yet, as highlighted in a recent report by the Public Health Agency of Canada, fewer than 20% of Canadians experiencing an osteoporotic fracture receive therapies to prevent further fractures.i

"We know that fractures, including those of the spine, wrist, and hip, after the age of 50, increase the chance of having another fracture within five years," says Dr. Alexandra Papaioannou, one of the study's lead authors. "This study reinforces the importance of appropriate medical intervention in helping prevent subsequent fractures, and the role education and technology can play in helping improve health outcomes for patients."


Using an electronic medical record (EMR)-based dashboard called the "ADVANTAGE OP EMR" tool, 84 physicians located across Canada shared their practice activities related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk for osteoporosis. 

Key results of the study included the following:

  • Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture. 
  • Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed. 
  • For patients with BMD completed, fracture risk was calculated in only 29%. 
  • Of those with fracture risk calculated, 19% were at high risk, of whom 37% were not treated with osteoporosis medications as recommended by CPG. 
  • Seventy-seven per cent of Ontario family physicians identified the lack of EMR tools as a significant barrier to implementing the osteoporosis clinical practice guidelines.

"Family physicians themselves have identified a need for clinical support tools that identify potential risk factors, calculate fracture risk, and offer advice on treatment options," adds Dr. Papaioannou.


The authors of the study developed the Dashboard Initiative for Quality Improvement in the Management of Patients with Osteoporosis (ADVANTAGE OP). The ADVANTAGE OP dashboard serves as a mechanism for alerting physicians of patients' potential fracture risk to improve screening and management. 

The ADVANTAGE OP EMR tool consists of an interactive algorithm to facilitate assessment and management of fracture risk using CPG. The FRAX® and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools were embedded to facilitate 10-year fracture risk calculation. Physicians managed patients as clinically indicated but with EMR reminders of guideline recommendations; participants shared practice level data on management activities after 18-month use of the tool.

"As a result of this program we have a better understanding of how physicians can be helped with EMR-based decision support tools to enable and facilitate optimal decision-making in patient management. At the same time, gathered data can help to inform the development of real-world strategies and tools that will better support the implementation of osteoporosis CPGs within primary care," says Dr Anatoly Langer, another of the study's lead authors.

This study was financially supported by Amgen Canada as an investigator-initiated study.  

About Osteoporosis

Osteoporosis is a condition that causes bones to become thin and porous, decreasing bone strength and leading to increased risk of breaking a bone.iv The most common sites of broken bones from osteoporosis are the wrist, spine, shoulder and hip.iv Osteoporosis can strike at any age, however it mainly affects women after menopause as their ability to form new bone cannot keep up with the rate at which bone is being lost.iv,v This bone loss leads to weakened bones over time, increasing the potential for a break.iv

At least one in three women and one in five men will suffer a broken bone from osteoporosis during their lifetime.iv Broken bones from osteoporosis are more common than heart attack, stroke and breast cancer combined.iv One in three people who break a hip will re-break it at one year, and over one in two will suffer another bone break within five years.iv

The World Health Organization has officially declared osteoporosis a public health crisisvi, while the International Osteoporosis Foundation urges governments worldwide to make osteoporosis a healthcare priority.vii  Recently, the Public Health Agency of Canada has also recognized osteoporosis as a major public health concern in Canada due to the significant morbidity, mortality and costs associated with osteoporotic fractures, combined with a large osteoporosis care gap.


As a leader in innovation, Amgen Canada understands the value of science. With main operations located in Mississauga, Ont.'s vibrant biomedical cluster, and its research facility in Burnaby, B.C., Amgen Canada has been an important contributor to advancements in science and innovation in Canada since 1991. The company contributes to the development of new therapies and new uses for existing medicines in partnership with many of Canada's leading health-care, academic, research, government and patient organizations. To learn more about Amgen Canada, visit

iPublic Health Agency of Canada. Osteoporosis and Related Fractures in Canada. August 23, 2021 
iiPapaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5:11 
iiiPapaioannou A, Kennedy CC, Ioannidis G, Gao Y, Sawka AM, Goltzman D, Tenenhouse A, Pickard L, Olszynski WP, Davison KS, Kaiser S, Josse RG, Kreiger N, Hanley DA, Prior JC, Brown JP, Anastassiades T, Adachi JD (2008) The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19:581–587. 
ivOsteoporosis Canada. Osteoporosis Facts and Statistics. Accessed August 30, 2021. 
vInternational Osteoporosis Foundation. Risk Factors Accessed August 30, 2021. 
viThe World Health Organization. Bulletin of the World Health Organization. Exercise interventions: defusing the world's osteoporosis time bomb. Available at: Accessed August 30, 2021 
viiInternational Osteoporosis Foundation. Policy and Advocacy.. Available at Accessed August 30, 2021 

SOURCE Amgen Canada


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