Patient engagement and care pathway continuity in structured osteoporosis management: real-world evidence from routine practice

Background Osteoporosis carries a substantial clinical burden, yet underdiagnosis and care pathway discontinuity remain common in routine practice. Structured care models integrating primary care and specialists may optimize disease assessment and care coordination. This study presented a retrospective descriptive evaluation of the operational implementation, patient-engagement patterns, and disease burden within a structured Health Bone Network (HBN) dedicated to osteoporosis care in a real-world setting. Methods We conducted a retrospective observational study of 1,631 individuals undergoing bone mineral density assessment by dual-energy X-ray absorptiometry (DXA) in 2021 within a coordinated primary care-specialist HBN. Care pathway continuity, report access rates, consultation attendance, clinical characteristics, and specialist management patterns were analyzed. Results Among 1,631 evaluated individuals (mean age was 64.6 ± 10.7 years; 92.5% female), 60.1% accessed their digital specialist report. Among those with an explicit recommendation for specialist evaluation, consultation attendance was 38.2%. Densitometric osteoporosis was diagnosed in 28.3% of participants with applicable criteria. In multivariable logistic regression analysis, female sex, advanced age, and personal history of fragility fractures emerged as independent clinical factors for osteoporosis (p< 0.05). Vitamin D supplementation was also positively associated with an osteoporotic T-score, a finding likely reflecting confounding by indication and reverse causation rather than an etiologic determinant. Conversely, diabetes mellitus was inversely associated with a densitometric diagnosis of osteoporosis (aOR=0.56, p = 0.018), highlighting a densitometric paradox in this population. Conclusion This study provides a baseline description of the operational implementation of a structured healthcare network integrating DXA reporting with primary care. While characterizing its operational structure, the substantial attrition rates along the care cascade highlight that digital data integration alone is insufficient to guarantee care continuity, offering a benchmark for future effectiveness evaluations and proactive engagement strategies.