The study by Andrade et al1 adds to our knowledge about the gap in medical care for osteoporosis at the time of a fracture. This gap has been described in academic2 and community hospitals.3,4 In managed care settings the cause for this gap is not lack of health insurance. In fact, in managed care practices, integrated medical services promote communication between orthopedic surgeons and primary care physicians. We can hypothesize that other explanations for this gap may include low awareness of osteoporosis in physicians, age bias, or competing comorbidities. In any case, we evidence that older adults are less likely to receive adequate care. The evidence from randomized clinical trials demonstrates significant treatment efficacy in older adults. The findings of Andrade and colleagues are in sharp contrast with managed care organizations' philosophy of emphasizing preventive services.
Edwards BJ. Solutions to the Undertreatment of Osteoporosis-Related Fractures. Arch Intern Med. 2004;164(6):677. doi:10.1001/archinte.164.6.677-a