Introduction: General practitioners (GPs) are key participants in osteoporosis (OP) management. The aim was to evaluate their adherence to lege artis management of the disease, potential barriers, and to discuss differences observed in comparison with the baseline survey carried out in 2007; the focus was on secondary prevention. Methods: On behalf of two professional associations, 2-round postal survey among randomly selected GPs (>1/4 of all Czech GPs) was performed in 2014. The questionnaire covered areas concerning GP's role in the fight against OP, knowledge about OP, management of OP-related fractures, barriers to the management of OP, system- and patient-related in particular, and availability and use of information sources. Results: The overall questionnaire return rate was 37% (551 respondents); mean age of the respondents was 53 year (37% men). The GP's role in the treatment of OP was rated as essential in 28 and 37% of men and women, respectively (P = 0.012). The guideline for diagnosis and treatment of OP for GPs was considered accessible by 92% of respondents. As much as 60% of the respondents were adherent to the guideline, i.e., used it repeatedly. The knowledge of several risk factors was very good, however, recommended daily intake of calcium was stated correctly by only 41% of respondents, and daily intake of vitamin D by only 40%. Three quarters reported active steps after a fracture: referral to a specialist, life-style recommendations, prescription of calcium/vitamin D supplements. Half of the respondents focus on fall prevention. System-related barriers, such as lack of possibility to prescribe selected drugs (61%) and financial limits set by health insurance company (44%) were most frequently reported. Patient-related barriers were also common, patient's non-adherence (reported by 29%) and patient's reluctance to go to a specialist (18%). Conclusion: GPs adhered to OP management more than in 2007. Knowledge of risk factors and involvement in post-fracture care was relatively high. Compared to baseline survey, patient-related barriers, patient non-adherence in particular, were more common. Prescribing conditions are still an important issue. Among GPs, education should be focused on calcium and vitamin D intake, doses, sources, and supplements.

Department of Rheumatology Faculty of Medicine Institute of Rheumatology Charles UniversityPrague Czechia

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Kralove Charles UniversityHradec Kralove Czechia

Department of Social Medicine Faculty of Medicine in Hradec Kralove Charles UniversityHradec Kralove Czechia

Faculty of Medicine in Hradec Kralove Charles University Hradec Kralove and University Hospital Hradec KraloveHradec Kralove Czechia

Zobrazit více v PubMed

Blazkova S., Vytrisalova M., Palicka V., Stepan J., Byma S., Kubena A. A., et al. . (2010). Osteoporosis risk assessment and management in primary care: focus on quantity and quality. J. Eval. Clin. Pract. 16, 1176–1182. 10.1111/j.1365-2753.2009.01289.x PubMed DOI

Blazkova S., Vytrisalova M., Stepan J., Palicka V., Byma S., Hala T., et al. (2012). Secondary prevention of osteoporosis among general practitioners. Osteol. Bull. 17, 32–35.

Bruyère O., Nicolet D., Compère S., Rabenda V., Jeholetm P., Zegels B., et al. . (2013). Perception, knowledge, and use by general practitioners of Belgium of a new WHO tool (FRAX) to assess the 10-year probability of fracture. Rheumatol. Int. 33, 979–983. 10.1007/s00296-012-2461-x PubMed DOI

Buckinx F., Reginster J. Y., Cavalier E., Petermans J., Ricour C., Dardenne C., et al. . (2016). Determinants of vitamin D supplementation prescription in nursing homes: a survey among general practitioners. Osteoporos. Int. 27, 881–886. 10.1007/s00198-015-3469-3 PubMed DOI

Chenot R., Scheidt-Nave C., Gabler S., Kochen M. M., Himmel W. (2007). German primary Care Doctor's awareness of osteoporosis and knowledge of national guidelines. Exp. Clin. Endocrinol. Diabetes. 115, 584–589. 10.1055/s-2007-981454 PubMed DOI

Cortet B. (2009). Postmenopausal osteoporosis: General practitioners' application of the risk factors in the AFSSAPS guidelines. Survey of 2658 general practitioners. Presse Med. 38, 1213–1219. 10.1016/j.lpm.2009.01.028 PubMed DOI

Cosman F., de Beur S. J., LeBoff M. S., Lewiecki E. M., Tanner B., Randall S., et al. (2014). National osteoporosis foundation. clinician's guide to prevention and treatment of osteoporosis. Osteoporos. Int. 25, 2359–2381. 10.1007/s00198-014-2794-2 PubMed DOI PMC

Dorner T., Lawrence K., Rebhandl E., Weichselbaum E., Rieder A. (2009). Opinions and attitudes concerning osteoporosis among Austrian general practitioners. Wien. Med. Wochenschr. 159, 247–252. 10.1007/s10354-009-0648-x PubMed DOI

Duyvendak M., Naunton M., van Roon E. N., Brouwers J. R. B. J. (2011). Doctor's beliefs and knowledge on corticosteroid-induced osteoporosis: identifying barriers to improve prevention. J. Clin. Pharm. Ther. 36, 356–366. 10.1111/j.1365-2710.2010.01185.x PubMed DOI

Fuksa L., Vytrisalova M. (2015). Adherence to denosumab in the treatment of osteoporosis and its utilization in the Czech Republic. Curr. Med. Res. Opin. 31, 1645–1653. 10.1185/03007995.2015.1065241 PubMed DOI

Kanis J. A., Johansson H., Oden A., Cooper C., McCloskey E. V. (2014). Epidemiology and quality of life working group of IOF. Worldwide uptake of FRAX. Arch. Osteoporos. 9:166 10.1007/s11657-013-0166-8 PubMed DOI

Kanis J. A., McCloskey E. V., Johansson H., Cooper C., Rizzoli R., Reginster J. Y., et al. . (2013). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos. Int. 24, 23–57. 10.1007/s00198-012-2074-y PubMed DOI PMC

Otmar R., Reventlow S. D., Nicholson G. C., Kotowicz M. A., Pasco J. A. (2012). General medical practitioners' knowledge and beliefs about osteoporosis and its investigation and management. Arch. Osteoporos. 7, 107–114. 10.1007/s11657-012-0088-x PubMed DOI

Palicka V., Blahos J., Byma S. (2011). Osteoporóza. Doporučený Diagnostický a Léčebný Postup Pro Všeobecné Praktické Lékaře. Novelizace 2011. Praha: Společnost Všeobecněho Lěkařství ČLS JEP.

Pérez-Edo L., Ciria Recasens M., Castelo-Branco C., López P. O., Marquéz A. G., Pérez C., et al. (2004). Management of osteoporosis in general practice: a cross-sectional survey of primary care practitioners in Spain. Osteoporosis Int. 5, 252–257. 10.1007/s00198-003-1569-y PubMed DOI

Reeder A. I., Jopson J. A., Gray A. R. (2012). “Prescribing sunshine”: a national, cross-sectional survey of 1,089 New Zealand general practitioners regarding their sun exposure and vitamin D perceptions, and advice provided to patients. BMC Fam. Pract. 13:85 10.1186/1471-2296-13-85 PubMed DOI PMC

Stepan J. J., Vaculik J., Pavelka K., Zofka J., Johansson H., Kanis J. A. (2012). Hip fracture incidence from 1981 to 2009 in the Czech Republic as a basis of the country-specific FRAX model. Calcif. Tissue Int. 90, 365–372. 10.1007/s00223-012-9582-9 PubMed DOI

Štěpán J., Vaculík J., Palička V., Dungl P., Vyskočil V., Pavelka K. (2015). Péče o pacienty s nízkotraumatickou zlomeninou horního konce stehenní kosti. Czech Rheumatol. Ceska Revmatol. 23 43–58.

Svedbom A., Hernlund E., Ivergård M., Compston J., Cooper C., Stenmark J., et al. (2013). EU Review Panel of IOF. Osteoporosis in the European Union: a compendium of country-specific reports. Arch. Osteoporos. 8:137 10.1007/s11657-013-0137-0 PubMed DOI PMC

Taylor J. C., Sterkel B., Utley M., Shipley M., Newman S., Horton M., et al. (2001). Opinions and experience in general practice on osteoporosis prevention, diagnosis and management. Osteoporos. Int. 12, 844–848. 10.1007/s001980170035 PubMed DOI

Vytrisalova M., Fuksa L., Palicka V., Byma S., Blazkova S., Stepan J., et al. (2014). Adherence to osteoporosis guideline: survey among Czech general practitioners. Cent. Eur. J. Med. 9, 687–693. 10.2478/s11536-013-0314-y DOI