The care gap in diagnosis and treatment of women with a fragility fracture

In women aged 50 years or more who experienced a fracture, 81% suffered a fragility fracture. Six to eight months after fragility fracture, 79% had either not been investigated for osteoporosis or prescribed anti-fracture therapy. Despite fragility fractures being common in this population osteoporosis is under-diagnosed and under-treated.

INTRODUCTION

The objective of this study was to evaluate the diagnostic and treatment rates for osteoporosis six months following fragility fracture.

METHODS

This prospective cohort study was set in the general community from the Province of Quebec, Canada. Women at least 50 years of age who suffered a fracture were recruited during their initial visit to the hospital and had their fracture type classified as either fragility or traumatic. Six-to-eight months after fragility fracture, women were again contacted to evaluate the diagnostic and treatment rates of osteoporosis.

RESULTS

Of the 2,075 women recruited over a 25 month period 1,688 (81%) sustained a fragility fracture and 387 (19%) sustained a traumatic fracture. Nine hundred and three participants with a fragility fracture were again contacted six-to-eight months after fracture. For the 739 women not on treatment on the recruitment day, only 15.4% initiated pharmacological therapy in the six-to-eight-month period following fracture and 79.0% had either not been investigated for osteoporosis or prescribed anti-fracture treatment.

CONCLUSIONS

The proportion of fragility fractures to total fractures is higher than previously reported. Despite the availability of diagnostic modalities, effective treatments, and adequate health care assessments, there is a substantial care gap in the management of osteoporosis.

When nurses and teachers strike: public perceptions of 'the betrayal'

This article examines how the public perceived both teachers and nurses during their first strikes in Victoria. How did the community react when two previously trusted groups of essential service workers "closed shop" and walked out. Reactions towards the teachers' and nurses' actions by the press, politicians and those members of the public who expressed themselves via the media are examined. While many of the arguments used in the public debate were similar, the most significant difference in the public's reaction was related to the gender of the leaders of the respective industrial organizations.