Osteoporosis Treatment Gap - A Systematic Literature Review.

Introduction: Osteoporosis is a common metabolic bone disease that increases fracture risk, particularly among older adults, and imposes a substantial global burden. Despite advances in risk assessment and treatment, a large treatment gap remains, with many high-risk individuals not receiving care. Methods: We conducted a systematic review of English-language studies published up to April 2025, identified through searches in multiple databases (PubMed, Scopus, Web of Science, ScienceDirect, Europe PMC). 43 studies were included. Due to the heterogeneity of study designs and treatment gap definitions, a narrative thematic synthesis was performed. Results: Reported treatment gap estimates varied widely (38.8-94.6%) across countries and study populations. Lower treatment rates were associated with patient factors (male sex, lower socio-economic status, comorbidities) and healthcare system factors (limited physician awareness, institutional barriers, poor interprofessional communication). Higher treatment rates were associated with older age, family history of osteoporosis, prior diagnosis or bone mineral density testing, and participation in structured care programmes. Conclusions: Substantial global treatment gaps in osteoporosis care persist, particularly following fragility fractures. These gaps arise from multiple patient, physician, and system-level factors, with persistent disparities by sex, ethnicity, comorbidities, and socio-economic status. Findings highlight the need for standardised definitions of the treatment gap and suggest areas for future research and intervention development.