[Evidence based comparative analysis for managing osteoporosis in a primary health care setting]. / Análisis comparativo frente a la evidencia del manejo de la osteoporosis en una comarca de atención primaria.

ABSTRACT

OBJECTIVE: To find out how physicians are managing osteoporosis in a primary care setting. DESIGN: Cross-sectional study. CONTEXT Primary care setting with a target population of 276,000 inhabitants, grouped into 9 basic health areas, Spain. PARTICIPANTS: Women older than 45 years old on treatments for osteoporosis. INTERVENTIONS: Standardised questionnaire self-filled in by women and compared with clinical records. MAIN MEASUREMENTS Suitability of the indication of diagnostic tests, proportion of treatments supported by diagnostic tests and according to evidence. RESULTS: The mean age of the sample was 65.3 (9.6) years. Of the women included, 73.2% (n=243) had an indication for densitometry and only 60.2% (n=200) of them had this performed. The results of the densitometries were 14% (n=28) normal, 31% (n=62) osteopenia and 55% (n=110) osteoporosis. Based on risk factors, in those women with densitometry indication, 39.5% (n=96) did not have it performed. In those women with no risk factors to justify the indication of densitometry (n=89), 59.6% (n=53) did have it performed. The two-year follow densitometry was not carried out on 78.7% (n=261) of women. Statistically significant differences were observed in the percentages of adequacy of the indications of densitometry and in the percentages of adequacy of the treatments in the different medical specialities analyzed (P < .05). Of the women who had densitometry, 42.4% (n=81) were inadequately treated. CONCLUSIONS: The indication of densitometry is clearly improvable and there is a high variability in its adequacy in all the medical specialities studied. To a great extent, the indication of treatments for osteoporosis is not based on densitometry and is against the recommendations of the evidence based studies recently published.