Are we closing the gaps in the management of osteoporosis following fragility fractures of the femur

Osteoporosis is a major issue in the developing world, and is associated with a financial as well as a social burden. The incidence of osteoporosis in Saudi Arabia has been reported as 39% in men and 33% in post-menopausal women.1 Furthermore, rates of morbidity and mortality are increased following fragility fractures.2 Although awareness of osteoporosis and its complications has been widely promoted by health care authorities, treatment strategies remain suboptimal. In 2014, a gap in treatment was reported to exist for approximately 30% of patients, a figure markedly lower than previously reported.3 Jennings et al. (2010)4 found that only 2% of patients were prescribed appropriate therapy of calcium, vitamin D, and an anti-resorptive or anabolic medication. Hajcsar et al. (2000)5 reported that among patients attending fracture clinics after a fragility fracture, only 20% received the appropriate treatment. Black, Follin, and McDermott (2001)6 reported that, compared with the general population, patients had an 8-fold increased risk for fracture of the contralateral hip after the first fragility fracture of the femur. Furthermore, the risk of a second hip fracture within 1 year was increased by 6%–12%.6–8 Finally, Chapuy and Meunier (1996)9 reported that the incidence of a second fracture was reduced by 30% with timely initiation of appropriate treatment. Our earlier analysis for 2000–20113 demonstrated a reduction in the treatment gap from 76% to 30%, and the objective of the present study was to evaluate whether this gap in the management of osteoporosis after fragility fracture of the femur has since been further reduced.