Bone Abstracts

Background: Primary care plays an essential role in the identification, investigation, treatment and follow-up of people with, or at risk of, osteoporotic fracture. Despite the availability of evidence-based management strategies, a global osteoporosis care gap exists. This qualitative interview study aimed to explore primary care professionals attitudes towards osteoporosis, their perceived roles in its management, and their confidence, knowledge, and clinical decision-making needs. The study also sought to identify opportunities to improve osteoporosis care delivery.

Methods: Primary care professionals consenting to contact in a previous national e-survey were invited to participate in a semi-structured interview. Purposive sampling sought to achieve maximal variation across geographical location, ethnicity, sex, age, and professional role. Analysis followed the seven stages of framework analysis, with themes deductively mapped to the Theoretical Domains Framework (TDF) to identify key behavioural determinants (e.g., knowledge and skills) underpinning barriers and enablers to evidence-based osteoporosis care.

Results: Sixteen primary care professionals (9 GPs, 2 First Contact Practitioners, 1 Physiotherapist, 1 Pharmacist, 1 Practice Nurse, 1 Advanced Nurse Practitioner, 1 Practice Manager) participated in interviews. Framework analysis generated 36 themes reflecting behavioural determinants of osteoporosis care, which were subsequently mapped to all 14 domains of the TDF. Several interrelated behavioural and systemic barriers to evidence-based osteoporosis care were identified. Osteoporosis was recognised as an important condition requiring greater prioritisation but was consistently described as complex and perceived to impose cognitive burden on both patients and clinicians. Participants highlighted challenges in supporting medication persistence, communicating risk-benefit, and navigating their clinical uncertainty. In the context of an overwhelmed primary care system, osteoporosis was frequently reported to be deprioritised due to competing demands. Perceived contributing factors include limited consultation time, ineffective financial incentives, fragmented digital infrastructure, and reactive, opportunistic approaches to case-finding and follow-up. Limited optimism about patient engagement with treatment further compounded these challenges.

Conclusion: The osteoporosis care gap in primary care reflects not a lack of awareness or motivation, but structural, behavioural, and organisational constraints. Interventions should target clinician capability, patient engagement, and system-level enablers to support more proactive, evidence-based osteoporosis care.