Professional positioning of general practitioners in the management of postmenopausal osteoporosis in community medicine.

Objectives: Although postmenopausal osteoporosis management has evolved in recent years, it nonetheless remains underdiagnosed and undertreated. Given that general practitioners (GPs) are the keystone of patient screening and referral in France, the present study was conducted to assess their professional positioning in the management of postmenopausal osteoporosis. Methods: This is a qualitative study based on semidirected interviews, carried out between July 2020 and February 2021. Alsatian GPs were randomly selected and interviewed until data saturation was achieved. The consolidated criteria for qualitative research reporting grid were used, as well as NVivo software to categorise the data. Results: Twenty-three GPs were interviewed. Study participants recognised that the investigation and treatment of osteoporosis begin at a primary care level, typically with the GP. Although some initiated screening by prescribing bone mineral density assessments, only a few prescribed the associated laboratory assessment and spinal X-rays in search of curable osteoarthritis or vertebral fracture. For those GPs who do take the opportunity to initiate treatments for patients, there is an understanding that first-line options often include calcium and vitamin D, at a preventive level. The interviewed physicians interacted mainly with gynaecologists and rheumatologists. Fracture liaison services were widely acclaimed. Several barriers were identified in their care management. The absence of a defined role between specialists and the lack of communication between them were additional highlighted barriers. Conclusions: GPs were unevenly involved in the management of osteoporosis; numerous barriers to care were identified.