Drugs & Aging

, Volume 24, Issue 7, pp 603–614 | Cite as

Characterisation of Patients with Postmenopausal Osteoporosis in French Primary Healthcare

  • Francis Blotman
  • Bernard Cortet
  • Pascal Hilliquin
  • Bernard Avouac
  • François-André Allaert
  • Denis Pouchain
  • Anne-Françoise Gaudin
  • François-Emery Cotté
  • Abdelkader El Hasnaoui
Original Research Article



The public health burden of osteoporosis is high, principally because of increased risk of fractures and associated morbidity, handicap and mortality. Osteoporotic fracture prevention is therefore an important public health goal. General practitioners (GPs) play a key role in the management of osteoporosis, both in ensuring timely diagnosis and in providing treatment. Little information is available on standards of care for postmenopausal women with osteoporosis in general practice.


The primary objective of this study was to describe risk factors and treatment in postmenopausal women with osteoporosis. Secondary objectives were to evaluate treatment compliance and to assess the impact of osteoporosis on quality of life.


This observational, cross-sectional, pharmacoepidemiological study was performed in a primary-care setting in France. A random sample of GPs recruited postmenopausal women with a diagnosis of osteoporosis who had been followed by the investigator for at least 2 years. At inclusion, investigators completed a questionnaire providing information on patient age, osteoporosis duration, risk factors and treatment history. The first three patients recruited by each investigator completed a questionnaire providing information on sociodemographic features, osteoporosis treatments and quality of life. Treatment compliance was quantified using the Test d’Evaluation de l’Observance and quality of life evaluated using the 12-item Short Form Health Survey (SF-12).


Overall, 389 physicians included 3097 patients, of whom 1053 completed the patient questionnaire. Risk factors for osteoporotic fracture were identified in 2148 patients (69.4%), most frequently personal or maternal antecedents of osteoporotic fracture and a low body mass index. Of these, 946 (44.0%) presented more than one risk factor. At the time of diagnosis, 629 patients (59.7%) presented fractures, which involved the vertebrae in 51.7% of cases, the wrist in 40.5% and the hip in 5.4%. Older patients were more likely to have fractures at the time of diagnosis and to have multiple fractures. After diagnosis, at least one new fracture occurred in 201 patients (19.2%). Multivariate logistic regression analysis identified age >70 years, diagnosis at least 10 years previously, diagnosis based on the presence of a fracture, biochemical and haematological evaluation at the time of diagnosis, and a change in osteoporosis treatment in the previous 2 years as being significantly associated with incident fracture risk. At inclusion, 1019 patients (97.4%) were receiving treatment for osteoporosis, most frequently weekly bisphosphonates (71.6% of treatments). Most patients (81.0%) had been treated for at least 1 year. Treatment compliance was high in 61% of patients and low in <5%. Patient variables associated with high compliance were being retired, prescription of bisphosphonates and, among the bisphosphonate users, prescription of weekly formulations. SF-12 quality-of-life scores were low, ranging from 38.6 (energy/vitality) to 65.1 (social functioning) out of a possible maximum score of 100. Baseline variables associated with SF-12 physical component summary scores included age, height loss since menopause, diagnosis following a fracture, fracture incidence since diagnosis, time since diagnosis and treatment with bisphosphonates.


In this study of postmenopausal osteoporosis in the French primary healthcare setting, many women with osteoporosis were diagnosed following a fracture. Although most were treated with bone-consolidating drugs, compliance was suboptimal in a significant minority. Osteoporotic fracture was associated with reduced quality of life.


Osteoporosis Vertebral Fracture Bisphosphonates Osteoporotic Fracture Raloxifene 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was funded by Laboratoires GlaxoSmithKline and Laboratoires Roche. The sponsors initiated the study, supervised its conduct and organised the preparation of the manuscript. Operational responsibility for the study was delegated to a contract research organisation (Nukleus) and data management and statistical analysis were performed by Cenbiotech. The academic authors (F. Blotman, B. Cortet, P. Hilliquin, B. Avouac, F.-A. Allaert and D. Pouchain) formed the scientific advisory board for the study and advised on the design of the protocol and the interpretation of the results. All received consultancy fees for their participation in the study. F.-A. Allaert is employed by Cenbiotech, who performed the data analysis. A.-F. Gaudin, F.-E. Cotté and A. El Hasnaoui are employees of Laboratoires GlaxoSmithKline.


  1. 1.
    National Institute of Health. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001 Feb 14; 285(6): 785–95CrossRefGoogle Scholar
  2. 2.
    Looker AC, Orwoll ES, Johnston Jr CC, et al. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 1997 Nov; 12(11): 1761–8PubMedCrossRefGoogle Scholar
  3. 3.
    Tenenhouse A, Joseph L, Kreiger N, et al. Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 2000; 11(10): 897–904PubMedCrossRefGoogle Scholar
  4. 4.
    Dargent-Molina P, Piault S, Breart G. Identification of women at increased risk of osteoporosis: no need to use different screening tools at different ages. Maturitas 2006 Apr 20; 54(1): 55–64PubMedCrossRefGoogle Scholar
  5. 5.
    Ross PD, Davis JW, Epstein RS, et al. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 1991 Jun 1; 114(11): 919–23PubMedGoogle Scholar
  6. 6.
    Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures: the Study of Osteoporotic Fractures Research Group. Lancet 1993 Jan 9; 341(8837): 72–5PubMedCrossRefGoogle Scholar
  7. 7.
    Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int 2005 Mar; 16Suppl. 2: S3–7PubMedCrossRefGoogle Scholar
  8. 8.
    Grados F, Marcelli C, Dargent-Molina P, et al. Prevalence of vertebral fractures in French women older than 75 years from the EPIDOS study. Bone 2004 Feb; 34(2): 362–7PubMedCrossRefGoogle Scholar
  9. 9.
    The European Prospective Osteoporosis Study Group. Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 2002 Apr; 17(4): 716–24CrossRefGoogle Scholar
  10. 10.
    Ismail AA, Pye SR, Cockerill WC, et al. Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 2002 Jul; 13(7): 565–71PubMedCrossRefGoogle Scholar
  11. 11.
    Baudoin C, Fardellone P, Potard V, et al. Fractures of the proximal femur in Picardy, France, in 1987. Osteoporos Int 1993 Jan; 3(1): 43–9PubMedCrossRefGoogle Scholar
  12. 12.
    Baudoin C, Fardellone P, Thelot B, et al. Hip fractures in France: the magnitude and perspective of the problem. Osteoporos Int 1996; 6Suppl. 3: 1–10PubMedCrossRefGoogle Scholar
  13. 13.
    Kanis JA, Johnell O, De Laet C, et al. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 2002 Jul; 17(7): 1237–44PubMedCrossRefGoogle Scholar
  14. 14.
    Center JR, Nguyen TV, Schneider D, et al. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 1999 Mar 13; 353(9156): 878–82PubMedCrossRefGoogle Scholar
  15. 15.
    Cooper C, Atkinson EJ, Jacobsen SJ, et al. Population-based study of survival after osteoporotic fractures. Am J Epidemiol 1993 May 1; 137(9): 1001–5PubMedGoogle Scholar
  16. 16.
    Maravic M, Le Bihan C, Landais P, et al. Incidence and cost of osteoporotic fractures in France during 2001: a methodological approach by the national hospital database. Osteoporos Int 2005 Dec; 16(12): 1475–80PubMedCrossRefGoogle Scholar
  17. 17.
    Wehren LE, Magaziner J. Hip fracture: risk factors and outcomes. Curr Osteoporos Rep 2003 Sep; 1(2): 78–85PubMedCrossRefGoogle Scholar
  18. 18.
    Empana JP, Dargent-Molina P, Breart G. Effect of hip fracture on mortality in elderly women: the EPIDOS prospective study. J Am Geriatr Soc 2004 May; 52(5): 685–90PubMedCrossRefGoogle Scholar
  19. 19.
    Baudoin C, Fardellone P, Bean K, et al. Clinical outcomes and mortality after hip fracture: a 2-year follow-up study. Bone 1996 Mar; 18(3 Suppl.): 149–57SCrossRefGoogle Scholar
  20. 20.
    Hasserius R, Karlsson MK, Jonsson B, et al. Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly: a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int 2005 Apr; 76(4): 235–42PubMedCrossRefGoogle Scholar
  21. 21.
    Jalava T, Sarna S, Pylkkanen L, et al. Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 2003 Jul; 18(7): 1254–60PubMedCrossRefGoogle Scholar
  22. 22.
    Kado DM, Duong T, Stone KL, et al. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 2003 Jul; 14(7): 589–94PubMedCrossRefGoogle Scholar
  23. 23.
    Kanis JA, Oden A, Johnell O, et al. Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 2004 Feb; 15(2): 108–12PubMedCrossRefGoogle Scholar
  24. 24.
    Melton III LJ. Excess mortality following vertebral fracture. J Am Geriatr Soc 2000 Mar; 48(3): 338–9PubMedGoogle Scholar
  25. 25.
    Naves M, Diaz-Lopez JB, Gomez C, et al. The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population. Osteoporos Int 2003 Jul; 14(6): 520–4PubMedCrossRefGoogle Scholar
  26. 26.
    Delmas PD. The use of bisphosphonates in the treatment of osteoporosis. Curr Opin Rheumatol 2005 Jul; 17(4): 462–6PubMedGoogle Scholar
  27. 27.
    Cranney A, Adachi JD. Benefit-risk assessment of raloxifene in postmenopausal osteoporosis. Drug Saf 2005; 28(8): 721–30PubMedCrossRefGoogle Scholar
  28. 28.
    Emkey RD, Ettinger M. Improving compliance and persistence with bisphosphonate therapy for osteoporosis. Am J Med 2006 Apr; 119 (4 Suppl. 1): S18–24PubMedCrossRefGoogle Scholar
  29. 29.
    Black DM, Arden NK, Palermo L, et al. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures: study of Osteoporotic Fractures Research Group. J Bone Miner Res 1999 May; 14(5): 821–8PubMedCrossRefGoogle Scholar
  30. 30.
    Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001 Jan 17; 285(3): 320–3PubMedCrossRefGoogle Scholar
  31. 31.
    Melton III LJ, Atkinson EJ, Cooper C, et al. Vertebral fractures predict subsequent fractures. Osteoporos Int 1999; 10(3): 214–21PubMedCrossRefGoogle Scholar
  32. 32.
    O’Neill TW, Felsenberg D, Varlow J, et al. The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 1996 Jul; 11(7): 1010–8PubMedCrossRefGoogle Scholar
  33. 33.
    Delmas PD, van de Langerijt L, Watts NB, et al. Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 2005 Apr; 20(4): 557–63PubMedCrossRefGoogle Scholar
  34. 34.
    Girerd X, Hanon O, Anagnostopoulos K, et al. Assessment of antihypertensive compliance using a self-administered questionnaire: development and use in a hypertension clinic [in French]. Presse Med 2001 Jun 16–23; 30(21): 1044–8PubMedGoogle Scholar
  35. 35.
    Ware Jr J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996 Mar; 34(3): 220–33PubMedCrossRefGoogle Scholar
  36. 36.
    Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006 Dec; 17(12): 1726–33PubMedCrossRefGoogle Scholar
  37. 37.
    Cumming RG. Nursing home residence and risk of hip fracture. Am J Epidemiol 1996 Jun 15; 143(12): 1191–4PubMedCrossRefGoogle Scholar
  38. 38.
    Brennan nee Saunders J, Johansen A, Butler J, et al. Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff. Osteoporos Int 2003 Jul; 14(6): 515–9PubMedCrossRefGoogle Scholar
  39. 39.
    Norton R, Campbell AJ, Reid IR, et al. Residential status and risk of hip fracture. Age Ageing 1999 Mar; 28(2): 135–9PubMedCrossRefGoogle Scholar
  40. 40.
    Schwartz EN, Steinberg DM. Prescreening tools to determine who needs DXA. Curr Osteoporos Rep 2006 Dec; 4(4): 148–52PubMedCrossRefGoogle Scholar
  41. 41.
    Cadarette SM, McIsaac WJ, Hawker GA, et al. The validity of decision rules for selecting women with primary osteoporosis for bone mineral density testing. Osteoporos Int 2004 May; 15(5): 361–6PubMedCrossRefGoogle Scholar
  42. 42.
    Richy F, Ethgen O, Bruyere O, et al. Primary prevention of osteoporosis: mass screening scenario or prescreening with questionnaires? An economic perspective. J Bone Miner Res 2004 Dec; 19(12): 1955–60PubMedCrossRefGoogle Scholar
  43. 43.
    ANAES. Ostéodensitométrie [absorbimétrie osseuse] sur 2 sites par methode biphotonique 2006 [online]. Available from URL: [Accessed 2007 May 25]
  44. 44.
    Amamra N, Berr C, Clavel-Chapelon F, et al. Estimated number of women likely to benefit from bone mineral density measurement in France. Joint Bone Spine 2004 Sep; 71(5): 409–18PubMedCrossRefGoogle Scholar
  45. 45.
    Maurel F, Levy E, Le Pen C. Le cût hospitalier des fractures ostéoporotiques en France. J Econ Med 1998; 16(2): 99–108Google Scholar
  46. 46.
    Albrand G, Munoz F, Sornay-Rendu E, et al. Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone 2003 Jan; 32(1): 78–85PubMedCrossRefGoogle Scholar
  47. 47.
    Chapurlat RD, Bauer DC, Nevitt M, et al. Incidence and risk factors for a second hip fracture in elderly women: the Study of Osteoporotic Fractures. Osteoporos Int 2003 Apr; 14(2): 130–6PubMedGoogle Scholar
  48. 48.
    Bartl R, Gotte S, Hadji P, et al. [Adherence with daily and weekly administration of oral bisphosphonates for osteoporosis treatment]. Dtsch Med Wochenschr 2006 Jun 2; 131(22): 1257–62PubMedCrossRefGoogle Scholar
  49. 49.
    McCombs JS, Thiebaud P, McLaughlin-Miley C, et al. Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 2004 Jul 15; 48(3): 271–87PubMedCrossRefGoogle Scholar
  50. 50.
    Rossini M, Bianchi G, Di Munno O, et al. Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int 2006; 17(6): 914–21PubMedCrossRefGoogle Scholar
  51. 51.
    Sambrook P. Compliance with treatment in osteoporosis patients: an ongoing problem. Aust Fam Physician 2006 Mar; 35(3): 135–7PubMedGoogle Scholar
  52. 52.
    Allaert FA. Influence of the sociodemographic and clinical profile of dyslipidaemic patients on their compliance with dietary advice combined with cholesterol-lowering drug treatment (Nutrivast survey) [in French]. Ann Cardiol Angeiol (Paris) 2004 Sep; 53(5): 279–89CrossRefGoogle Scholar
  53. 53.
    More DR, Hagan LL. Factors affecting compliance with allergen immunotherapy at a military medical center. Ann Allergy Asthma Immunol 2002 Apr; 88(4): 391–4PubMedCrossRefGoogle Scholar
  54. 54.
    Cramer JA, Amonkar MM, Hebborn A, et al. Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 2005 Sep; 21(9): 1453–60PubMedCrossRefGoogle Scholar
  55. 55.
    Ettinger MP, Gallagher R, MacCosbe PE. Medication persistence with weekly versus daily doses of orally administered bisphosphonates. Endocr Pract 2006 Sep–Oct; 12(5): 522–8PubMedGoogle Scholar
  56. 56.
    Recker RR, Gallagher R, MacCosbe PE. Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 2005 Jul; 80(7): 856–61PubMedCrossRefGoogle Scholar
  57. 57.
    Cramer JA, Lynch NO, Gaudin AF, et al. The effect of dosing frequency on compliance and persistence with bisphosphonate therapy in postmenopausal women: a comparison of studies in the United States, the United Kingdom, and France. Clin Ther 2006 Oct; 28(10): 1686–94PubMedCrossRefGoogle Scholar
  58. 58.
    Cortet B, Benichou O. Adherence, persistence, concordance: do we provide optimal management to our patients with osteoporosis? Joint Bone Spine 2006 Oct; 73(5): e1–7PubMedCrossRefGoogle Scholar
  59. 59.
    Brenneman SK, Barrett-Connor E, Sajjan S, et al. Impact of recent fracture on health-related quality of life in postmenopausal women. J Bone Miner Res 2006 Jun; 21(6): 809–16PubMedCrossRefGoogle Scholar
  60. 60.
    Cockerill W, Lunt M, Silman AJ, et al. Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 2004 Feb; 15(2): 113–9PubMedCrossRefGoogle Scholar
  61. 61.
    van Schoor NM, Smit JH, Twisk JW, et al. Impact of vertebral deformities, osteoarthritis, and other chronic diseases on quality of life: a population-based study. Osteoporos Int 2005 Jul; 16(7): 749–56PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Francis Blotman
    • 1
  • Bernard Cortet
    • 2
  • Pascal Hilliquin
    • 3
  • Bernard Avouac
    • 4
  • François-André Allaert
    • 5
  • Denis Pouchain
    • 6
  • Anne-Françoise Gaudin
    • 7
  • François-Emery Cotté
    • 7
  • Abdelkader El Hasnaoui
    • 7
  1. 1.Rheumatology DepartmentMontpellier University HospitalMontpellierFrance
  2. 2.Rheumatology DepartmentHôpital Roger SalengroLilleFrance
  3. 3.Rheumatology DepartmentSud Francilien HospitalCorbeil-EssonneFrance
  4. 4.OFOS (Observatoire Français pour l’Ostéoporose)ParisFrance
  5. 5.Biostatistics Department, CenbiotechRegional University HospitalDijonFrance
  6. 6.General Practice DepartmentUFR CréteilCréteilFrance
  7. 7.GlaxoSmithKline LaboratoryMarly-le-Roi CedexFrance

Personalised recommendations