A high proportion of Canadian orthopedic respondents identified themselves as supporting the current emphasis on addressing osteoporosis in fragility fracture patients; most were unconcerned about medicolegal issues related to doing so. Most said they were engaged in osteoporosis care, either through referral or personal investigation, and were comfortable with prescribing treatments including calcium, vitamin D and, to a lesser degree, bisphosphonates. Of note was the finding that older surgeons were more likely than younger surgeons to personally investigate and treat for osteoporosis.
These findings collectively suggest that at least this sample of Canadian orthopedic surgeons is committed to osteoporosis care. However, previous studies demonstrate that in Canada and in other economically advanced countries only a small proportion of fragility fracture patients are receiving appropriate osteoporosis care.16
The discrepancy between attitudes and former behaviours may relate to difficulties in achieving osteoporosis interventions in busy fracture clinics and inpatient orthopedic environments. It may also reflect a recent change in attitudes resulting from various Canadian and international initiatives to inform orthopedic surgeons about this type of management.
Barriers to osteoporosis care for fragility fracture patients include cost of therapy, time and cost of diagnosis and treatment, concerns about the effectiveness of medications and lack of clarity about who is responsible for the initiation and management of these medications.16
Several Ontario programs are currently targeting osteoporosis management in the fragility fracture patient population. The Osteoporosis Exemplary Care Program at St. Michael's Hospital, Toronto, uses a full-time osteoporosis coordinator and has improved the rate of osteoporosis referral to over 95% for both inpatient and outpatient populations.18
The Ontario Orthopaedic Association– Osteoporosis Canada “Lucky Break” program, implemented in all 72 Ontario fracture clinics where there is orthopedic involvement, increased clinic staff awareness of osteoporosis in fragility fracture patients.19
Several other programs across Canada are also addressing postfracture osteoporosis care.20–23
The Ontario Ministry of Health and Long-Term Care has announced funding for a provincial osteoporosis strategy that will include postfracture osteoporosis screening in fracture clinics.
A potential source of bias is that orthopedic surgeons most interested in osteoporosis care possibly self-selected to attend the COA plenary session and participate in the polling. The circumstances surrounding the meeting represent another potential source of selection bias; it was originally planned to take place in Toronto but was moved to Winnipeg owing to the SARS situation, with a consequent lower attendance rate. Finally, the lower response rate to 2 questions in this real-time poll (regarding current practice when treating a patient who has a fragility fracture and medicolegal issues) introduces a level of uncertainty to interpreting the data for these questions. Possibly, some attendees briefly stepped out of the room and missed a question, the available responses might not have been clear, or they could not decide which response best reflected their own practices.
The polling results at this conference demonstrate that the orthopedic representatives who participated (and possibly the wider Canadian orthopedic community) consider themselves to be currently engaged or ready to engage in osteoporosis care for fragility fracture patients. The polling results suggest that Canadian orthopedic surgeons are highly aware of osteoporosis in fragility fracture patients and largely positive about participation in care. Interested parties should now shift focus to identifying and providing the resources and system modifications that are required to support these attitudes and to enable Canadian orthopedic surgeons to effectively provide osteoporosis care to their fragility fracture patients.