Osteoporosis Treatment Gap — A Systematic Literature Review

Male sex (22, 24,25,26, 30,31,32, 34,35,36,37, 40, 45–46, 50,51,52, 61)

Age: in most studies (21, 28–29, 35, 37, 40–41, 46, 49, 50–51, 61), older people are more likely to be treated; some studies show the opposite (26, 31, 38)

Body mass index of 30 and over (34, 51)

Minority racial and ethnic groups (marginalised groups) (21, 33–34, 39, 50,51,52)

Lower socio-economic status (40, 61)

Lower education levels (23)

Lower annual income (49)

Socioeconomically disadvantaged residential areas (40)

Current tobacco use (34)

Married status (49)

Family history of osteoporosis or fragility fractures (31, 51)

No documented previous fragility fractures (31)

Non-vertebral fractures (26–27, 33, 58, 61)

Non-major osteoporotic fracture (21, 37)

Dementia (22, 33)

Diabetes (28, 31, 38)

Chronic liver disease (28)

Chronic kidney disease (28, 33, 62)

Cardiovascular disease and hypertension (28, 38)

Arthritis (34)

Gastrointestinal troubles (38)

Comorbidity (20, 45, 60), high Charlson comorbidity index score (23, 33, 58)

Rheumatoid arthritis and systemic lupus (28, 51)

Diagnosis of osteoporosis or bone mineral density testing before a fragility fracture (21, 29, 36, 43–44, 48, 58)

Low bone mineral density score (25, 41)

Polypharmacy (26, 45, 57)

Oestrogen-only hormone replacement therapy (28)

Corticosteroids (28, 51, 58)

Prior vitamin D and calcium prescriptions (41)

Cost of treatment (49, 54, 60)

Low adherence (47)

Refusal of treatment (60)

Belief that osteoporosis is not serious (49)

More frequent doctor visits (51)

Lack of osteoporosis awareness (54)

Limited familiarity with treatment (47, 53)

Fear of anti-osteoporotic medications side effects (as perceived barrier by physicians) (54, 60)

Workload concerns (53)

Differences in prescription practices (46, 61–62)

Differences in referral practices (62)

Risk assessment not routine practice (44, 47, 55)

Failure to investigate (47, 56)

Knowledge gaps and lack of confidence (53)

Lack of comfort with making treatment changes (60)

Intentions to modify the treatment plan (60)

Disagreement with recommendations (60), reservations about protocol-based approaches (53)

Preference for Fracture Liaison Service (FLS) programmes over standard care (53)

Perception by general practitioners that preventive therapy is a specialist's responsibility (57)

Interprofessional communication issues and role ambiguity (44, 59)

Belief that the current care plan was appropriate (60)

Specialist-prescribed treatment plans limiting other providers’ interventions (60)

– Transfer to a rehabilitation (42) or a geriatric unit (42)

– Preference for FLS (53)

Lack of patient education and awareness (44, 49, 55, 59)

Long intervals between fracture and outpatient visit (25)

Length of hospital stay (42)

Bone-strengthening or community-based physical activity programmes rare (55)