Primary care physicians play a central role in both preventing osteoporosis and implementing secondary fracture prevention. The surveyed work was embedded within the INTERCEPT cluster-randomized trial, which focused on patients identified as having a potential minimal trauma fracture and on engaging general practitioners (GPs) with best-practice guidance for osteoporosis management.
The INTERCEPT trial identified patients with potential minimal trauma fractures and sent alerts to their GPs together with recommended osteoporosis management guidance. Four weeks after each alert, participating GPs were surveyed to capture their perspectives and to record clinical decisions regarding osteoporosis-directed investigations and treatments. The follow-up survey measured GP classification of the fracture (minimal trauma, not minimal trauma, or uncertain) and subsequent actions such as ordering a DXA scan or starting pharmacologic treatment.
Out of 170 GP survey responses, 76 fractures (44.7%) were classified by the responding GPs as minimal trauma, 60 fractures (35.3%) as not minimal trauma, and 34 cases (20.0%) were considered uncertain. The survey data indicated that GPs were more likely to classify a fracture as minimal trauma when it involved the spine and when the patient was older or female.
Among the 76 fractures that GPs judged to be minimal trauma, only 44 patients (57.9%) underwent dual energy X-ray absorptiometry (DXA) scanning. Thus, a substantial proportion of patients with fractures considered by their GP to represent potential fragility fractures did not receive DXA within the four-week follow-up interval used for the survey.
Initiation of osteoporosis-directed treatment was also limited. Of the 76 fractures judged to be minimal trauma, fewer than half (n = 34) of the corresponding patients were commenced on osteoporosis pharmacologic therapy within the period captured by the survey. This demonstrates a gap between fracture identification as potentially osteoporotic and actual commencement of guideline-recommended treatment in primary care settings.
GP-reported reasons for withholding or delaying treatment despite classifying a fracture as minimal trauma included DXA T-scores above −2.5 standard deviations and cases where treatment was deferred pending confirmation by DXA. The survey highlights a frequent reliance on DXA results to confirm osteoporosis prior to initiating therapy, even in the presence of a fracture that many guidelines would consider sufficient to diagnose osteoporotic fracture or to trigger treatment evaluation.
The survey findings show that rates of osteoporosis-directed investigation and treatment after minimal trauma fractures in primary care are below recommended levels. A notable barrier identified by responding GPs is the reliance on DXA confirmation before initiating treatment, which contributes to under-treatment despite recognition of a minimal trauma fracture.
These results suggest a persistent gap between observed primary care practices and established secondary fracture prevention guidelines. The data support efforts to increase guideline awareness among GPs, to promote pathway changes that permit treatment decisions based on fracture history when appropriate, and to address operational barriers to timely DXA assessment where confirmation is required.
The abstract does not provide detailed information on survey response bias, representativeness of responding GPs, timing beyond the four-week window, or longer-term follow-up of investigation and treatment rates; those details were not reported in the source abstract.
(Notes: All data and conclusions above are drawn from the survey results as reported in the PubMed abstract for the INTERCEPT trial publication. Additional study details beyond the abstract were not reported in the source material provided.)