Background: Osteoporosis is a major public health issue in Europe, responsible for a substantial burden of fragility fractures, disability and mortality. Despite the availability of effective diagnostic tools and pharmacological therapies, osteoporosis remains largely underdiagnosed and undertreated, particularly among individuals at high fracture risk. Across Europe, approximately 21 million women were eligible for osteoporosis treatment in 2019, yet around 71% remained untreated, defining a major treatment gap. This gap varied between countries but was particularly pronounced in France, where nearly 79% of women at high fracture risk did not receive anti-osteoporotic therapy. Limited access to bone mineral

density examination, and the absence of systematic post-fracture care pathways contribute substantially to this diagnostic and therapeutic gap. Quantifying the reasons of this care gap is essential to improve secondary fracture prevention strategies.

Objectives: To assess the general knowledge, beliefs and perceptions of postmenopausal French women in the Bourgogne-Franche-Comté region (2,800 000 inhabitants, 2 University hospitals), regarding osteoporosis, based on their fracture status and treatment history, given that a lack of information about osteoporosis and its risks could significantly impact the management and compliance with anti-fracture treatment among women, whether or not they have experienced a fracture.

Methods: This study aimed to explore knowledge, beliefs and attitudes towards osteoporosis using a crosssectional quantitative and qualitative approach. A total of 150 postmenopausal women from the Franche-Comté region, aged between 45 and 85, took part in the study. The study population was divided into three balanced groups of 50 patients, according to fracture status: no fractures, one fracture and multiple fractures. All fractures were of proven osteoporotic origin. Patients without fractures were recruited prospectively during general medical consultations. Patients in the fractured groups were recruited from the database of the Hôpital Nord Franche-Comté, among patients admitted to hospital. Following a fracture (wrist, vertebra, hip or humerus) in 2024. Patients were interviewed using two questionnaires: the first questionnaire studied the level of knowledge regarding the risk factors of osteoporosis; the second assessed beliefs and knowledge about osteoporosis and its treatment. Two scores, ranging from 0 to 20, were obtained. Demographic characteristics, osteoporosis treatments, risk factors and healthcare journey were also recorded. Patients were also asked to semi-quantitatively assess how concerned they were by osteoporosis.

Results: The average age at inclusion was 66.7 years, 69.8 years, and 71.6 years respectively in the control group, patients with a first fracture, and patients with multiple fractures. The difference was statistically significant (p = 0.02). Only 4%, 34% and 42% of the control group, patients with a first fracture and patients with multiple fractures, respectively, took calcium supplements. The respective proportions for vitamin supplementation were 48%, 66% and 86%. None of the patients in the control group were taking anti-osteoporotic treatment, compared with 12% of those with a first fracture and only 30% of those with multiple fractures. Bone densitometry was prescribed for 26% of the control group, 50% of patients with a first fracture and 66% of patients with multiple fractures (p<0.001). When asked, ‘‘Are you concerned about osteoporosis?,” 50% of the controls, 75% of those with a first fracture, and 85% of those with multiple fractures answered ‘yes’. The average general knowledge/beliefs score was 13.4/20 (range 9–17), and the average risk factor knowledge score was 12.9/20 (range 7–19), with no significant difference between the three groups. However, high questionnaire scores were significantly associated with higher education, intellectual occupations, having undergone a bone densitometry scan, and calcium intake (all p<0.02). Surprisingly, 47% of patients with fractures did not consider osteoporosis to be a disease. Among women who had suffered a first fracture, only 30% knew they had osteoporosis; this figure was hardly higher among those who had suffered multiple fractures, at 50%.Regarding treatment, 38% of patients with a first fracture said they had discussed osteoporosis with their doctor, compared to 66% of patients with multiple fractures.

Conclusions: Even among patients who have suffered multiple fractures, knowledge of osteoporosis among postmenopausal women in Franche-Comté is very limited. Unfortunately, treatment is also inadequate, in line with national data. It is crucial to educate general practitioners and primary care providers about the risk factors for osteoporosis and the appropriate treatment following the first fracture, with the aim of preventing subsequent fractures. Informing women about osteoporosis, its severity, risk factors, and prevention as soon as they reach menopause is essential if we want to improve prevention and ensure early and long-term management of the disease.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.