The osteoporosis diagnosis and treatment gaps among Iranian women

Background Despite the availability of diagnostic tools and effective treatments for osteoporosis (OP), many women do not receive adequate care. This study seeks to explore the care gaps for OP among postmenopausal women. Methods This cross-sectional observational study was carried out in a city in Western Iran, where data were collected from women aged 50 and older through simple random sampling. Participants were initially evaluated using the Fracture Risk Assessment Tool (FRAX). Subsequently, a questionnaire was created covering three key areas: socioeconomic status, assessment, and medication initiation and adherence. Multiple logistic regression analysis was conducted to identify the factors associated with under-assessment and under-treatment of OP. Statistical analyses were performed using Stata 14 software. Results A total of 998 women with a mean age of 64.6 ± 10.4 participated in this study. Overall, 346 (34.6%) women were at high risk of fragility fractures through FRAX, of which 130(37.5%) had already undergone BMD, 109(83.8%) had been diagnosed with OP, and 98(89.9%) had been initiated on treatment. In addition, among the patients who had initiated treatment, 54 (55.1%) did not adhere to the treatment. Among the high-risk population, the OP diagnosis gap was estimated at 68.5%. Among those who were diagnosed with OP, the initiation to treatment gap and treatment gap were 10.1% and 71.6%, respectively. Elementary education (OR = 4.80, 95%CI: 1.65–13.99, P = 0.004), rural residence (OR 0.52, 95% CI: 0.3–0.91, P = 0.022), and awareness of OP (OR = 6.03, 95%CI: 3.38–10.73, P < 0.001) were associated with the OP diagnosis gap. Our study did not show any association between the variables examined and the OP treatment gap. Conclusions There is a significant gap in osteoporosis care for women aged 50 and older in Iran. Increasing awareness about the importance of bone health assessments, particularly among menopausal women who face a higher risk of fragility fractures, along with improving access to quality care, could help close this gap.