Background: Osteoporosis is underdiagnosed and undertreated in Australia. This audit assessed Australian GPs management of osteoporosis compared with best practice guidelines.
Method: GPs participated in a chronic disease management program, using a PDSA process designed to improve identification and management of patients at risk of initial or subsequent osteoporotic fracture. Patients not previously diagnosed with, or treated for osteoporosis were identified by screening of medical records, specifically: 1. Patients aged 70+; Patients with suspected fragility fracture since age 50. Eligible patients were recalled for bone health assessment and GPs collected data on relevant history, osteoporosis risk factors and management.
Results: A total of 740 GPs from 490 practices completed 3,799 patient assessments between 31/3/2017 and 31/12/2019. Among 3,634 patients aged 70 years and over, 3,466 (95%) were referred for DXA bone density assessment, with 56% having poor bone health (T-score < -1.0). Of the 18% of patients with a T-score ? -2.5 (i.e. osteoporosis), 81% received pharmacotherapy as per RACGP guidelines. In the 70+ group, 462 patients (12%) had a prior fragility fracture. DXA results were available for 444 patients of which 111 (25%) had a T-score ? -2.5. In this sub-group, 94 (85%) received pharmacotherapy. In the 192 patients with T-score > -2.5 and < -1.0, 71 (37%) were treated. There were 156 patients aged 50-69 years with prior fragility fracture (9 with no prior fracture were excluded), and only 83 (53%) of these received pharmacotherapy. Treatment was prescribed for 92% of those with T-score ? -2.5 (48 of 52), and for 29% of those with T-score > -2.5 (25 of 85). Across the overall cohort, the most common reason for not having DXA was patient refusal (29%), followed by more urgent conditions to treat (7%) and patient too old (7%, mean age 90 years).
Discussion: The findings from the REFRAME Clinical Audit confirm that osteoporosis remains under-recognised in Australian general practice. However, it also demonstrated that, even though GPs had not done so, they were readily able to identify patients at risk of fracture.
Implications for practice: The wider use of a systematic process for the identification and management of patients with poor bone health could enable GPs to manage fracture risk according to best practice guidelines, and has the potential to significantly reduce the osteoporosis management gap.