ArticleCureus2026
Reality of Osteoporosis in Primary Healthcare: An Observational Study in a Portuguese Local Health Unit.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
introductionOsteoporosis (OP) is a common chronic condition associated with an increasing burden of fragility fractures and healthcare costs. Risk assessment and management rely on tools such as the Fracture Risk Assessment Tool (FRAX®) and dual-energy X-ray absorptiometry (DXA), yet their application in routine primary healthcare (PHC) practice remains unclear.
objectivesTo characterize real-world OP screening and management practices in a PHC setting. MATERIALS AND
methodsA single observational study with two predefined cohorts was conducted across five family health units (FHUs). The screening cohort included individuals aged exactly 50 years, women aged exactly 65 years, and men aged exactly 70 years attending consultations at those ages. The OP cohort included patients with a confirmed diagnosis of OP established between 2013 and 2023. Data were collected from electronic medical records, anonymized, and analyzed using descriptive statistical methods (IBM
resultsIn the screening cohort (n=770), FRAX® was not registered in 99.6% of individuals aged 50 years. DXA was not requested in 87% of women aged 65 years and 97.2% of men aged 70 years. In the OP cohort (n=679), 49.2% of patients with a diagnosis duration of two years or more underwent follow-up DXA. Physician-advised bisphosphonate discontinuation occurred in 14.4% of cases and was considered appropriate in 61.5%, based on predefined clinical criteria. In contrast, most patient-initiated bisphosphonate discontinuations occurred without documented clinical justification. Although 16.9% of patients met criteria for referral (bisphosphonate refractoriness, osteoporotic fracture, or suspected secondary OP), 75.7% were not referred to rheumatology.
conclusionOP screening and management in primary healthcare showed low utilization of FRAX® and DXA, inconsistent follow-up, suboptimal long-term treatment adherence, and limited referral to rheumatology, reflecting gaps in real-world clinical practice.
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