Primary Health Care Research & Development


Missed opportunities for osteoporosis management in older patients: a literature review

Nishma Maneka1 c1

a1 Faculty of Medicine, Imperial College London, South Kensington, London, UK


Background Osteoporosis is a chronic and progressive disease leading to gradual deterioration of skeletal tissue, which predisposes the sufferer to an increased risk of fracture, deformity, disability and even premature death. The growth of this ‘silent epidemic’ is projected to escalate worldwide with the changing demographics of an ageing population. Recent reviews have highlighted the frequency of missed opportunities for secondary prevention following a fracture, though these reported on practice in the mid-1990s when pharmacologic approaches to fracture reduction were in transition.

Aim This review examines the current body of literature regarding the investigation of osteoporosis and prescribing of secondary bone prevention medication in older patients following fragility fractures.

Method A standard Boolean search framework was used to find all pertinent studies on the literature review question. A further set of results was obtained using a ‘snowballing’ technique by pursuing references of the initial studies and reviews found. As the aim was to determine if there have been changes in prescription rates in elderly patients in the light of new guidelines, studies were excluded if they had featured in recent systematic reviews.

Findings The consistently low intervention rates reported in all included studies provide evidence that elderly individuals who experience fragility fractures are still not receiving adequate investigation or treatment for osteoporosis. Furthermore, this review has identified the potential for future research to describe the true extent of this problem in the UK.

(Received June 16 2009)

(Accepted November 12 2009)

(Online publication January 28 2010)

Key words

  • fragility fracture;
  • investigation;
  • osteoporosis;
  • secondary bone prevention


c1 Correspondence to: Nishma Manek, Imperial College London, Exhibition Road, South Kensington, London, UK. Email: