1
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Rogers B, Famenini S, Perin J, Danila MI, Wipfler K, Michaud K, McMahan ZH. Clinical Features Associated With Rate of Fractures in Patients With Systemic Sclerosis: A US Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:2379-2388. [PMID: 37093022 PMCID: PMC10836612 DOI: 10.1002/acr.25137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is associated with several specific risk factors for fracture due to the complications of the disease and related medications. The present study was undertaken to examine the relationship between SSc-associated clinical features and fracture rate in a large US cohort. METHODS Participants with SSc in FORWARD, The National Databank for Rheumatic Diseases, were included (1998-2019). Age- and sex-matched individuals with osteoarthritis (OA) from the same database were included as comparators. The primary end point was self-reported major osteoporotic fracture. Cox proportional hazards models were used to study the associations between risk factors and fractures. RESULTS The study included 922 individuals (SSc patients, n = 154; OA patients, n = 768). Eighty-seven percent were female, with a mean age of 57.8 years. Fifty-one patients developed at least 1 fracture during a median of 4.2 years (0.5-22.0 years) of follow-up. Patients with SSc had more frequent fractures compared to OA comparators (hazard ratio [HR] 2.38 [95% confidence interval (95% CI) 1.47-3.83]). Among patients with SSc, a higher Rheumatic Disease Comorbidity Index score (HR 1.45 [95% CI 1.20-1.75]) and a higher Health Assessment Questionnaire disability index score (HR 3.83 [95% CI 2.12-6.93]) were associated with more fractures. Diabetes mellitus (HR 5.89 [95% CI 2.51-13.82]) and renal disease (HR 2.43 [95% CI 1.10-5.37]) were independently associated with fracture among SSc patients relative to SSc patients without these comorbidities. CONCLUSION Our findings highlight factors associated with fracture among patients with SSc. Disability as measured by the HAQ DI is a particularly strong indicator of fracture rate in SSc. Improving SSc patients' functional status, where possible, may lead to better long-term outcomes.
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Affiliation(s)
| | | | - Jamie Perin
- Johns Hopkins University, Baltimore, Maryland
| | - Maria I Danila
- University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham
| | - Kristin Wipfler
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha
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2
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Jackson LE, Saag KG, Chiriboga G, Lemon SC, Allison JJ, Mudano A, Rosas G, Foster PJ, Danila MI. A multi-step approach to develop a "storytelling" intervention to improve patient gout knowledge and improve outpatient follow-up. Contemp Clin Trials Commun 2023; 33:101149. [PMID: 37397431 PMCID: PMC10313880 DOI: 10.1016/j.conctc.2023.101149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/06/2023] [Accepted: 05/13/2023] [Indexed: 07/04/2023] Open
Abstract
Background "Storytelling" interventions influence knowledge, attitudes and behavior to promote chronic disease management. We aimed to describe the development of a video "storytelling" intervention to increase gout knowledge and promote adherence to medications and follow-up care after an acute gout flare visit in the emergency department. Methods We developed a direct-to-patient storytelling intervention to mitigate modifiable barriers to gout care and promote outpatient follow-up and medication adherence. We invited adult patients with gout as storytellers. We utilized a modified Delphi process involving gout experts to identify key themes to guide development of an intervention. Using a conceptual model, we selected stories to ensure delivery of evidence-based concepts and to maintain authenticity. Results Our video-based storytelling intervention consisted of segments addressing modifiable barriers to gout care. Four diverse gout patients were recruited as storytellers and interviewed with questions that covered gout diagnosis and care. Eleven international gout experts from diverse geographic locations generated and ranked items they considered important messages to promote outpatient gout care follow-up and treatment adherence. Filmed videos were truncated into segments and coded thematically. Distinct segments that captured desired messages were combined to form a cohesive narrative story based on gout patient experiences that conveyed evidence-based strategies to manage gout. Conclusions Using the Health Belief Model, we developed a culturally appropriate narrative intervention containing "storytelling" that can be tested as an approach to improve gout outcomes. The methods we describe may be generalizable to other chronic conditions requiring outpatient follow-up and medication adherence to improve outcomes.
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Affiliation(s)
- Lesley E. Jackson
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Germán Chiriboga
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Stephenie C. Lemon
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Jeroan J. Allison
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Amy Mudano
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Giovanna Rosas
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phillip J. Foster
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria I. Danila
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
- Geriatrics Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
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3
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Harasym P, Beaupre LA, Juby AG, Kivi P, Majumdar SR, Hanson HM. Cultural Knowledge in Context - People Aged 50 Years and Over Make Sense of a First Fracture and Osteoporosis. J Patient Exp 2023; 10:23743735231151537. [PMID: 36687165 PMCID: PMC9850129 DOI: 10.1177/23743735231151537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Catch a Break (CaB) is a secondary fracture prevention program that uses medical understandings of osteoporosis to assess first fractures and determine appropriateness for secondary fracture prevention. In this study, we interviewed CaB program participants to identify the understandings that patients themselves used to make sense of first fractures and the osteoporosis suggestion as cause. Semi-structured interviews were conducted with female and male participants of the CaB program in Canada. An interpretive practice approach was used to analyze the data. A random sample of 20 individuals, 12 women, and eight men all aged 50 years and over participated. First fractures were produced as meaningful in the context of osteoporosis only for seniors of very advanced age, and for people of any age with poor nutrition. The trauma events that led to a first fracture were produced as meaningful only if perceived as accidents, and having an active lifestyle was produced as beneficial only for mental health and well-being unrelated to osteoporosis. Cultural knowledge shapes, but does not determine, how individuals make sense of their health and illness experiences. Risk prevention program designers should include patients on the design team and be more aware of the presumptive knowledge used to identify individuals at risk of disease.
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Affiliation(s)
- Patricia Harasym
- Cumming School of Medicine, University of
Calgary, Calgary, Alberta, Canada,Heather M Hanson, Cumming School of
Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta
T2N 4Z6 Canada.
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine,
University of
Alberta, Edmonton, Alberta, Canada,Department of Orthopedics, Faculty of Medicine, University of
Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Angela G Juby
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada
| | - Paul Kivi
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada
| | - Sumit R Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada,School of Public Health, University of Alberta, 3-300 Edmonton
Clinic Health Academy, Edmonton, Alberta, Canada
| | - Heather M Hanson
- Cumming School of Medicine, University of
Calgary, Calgary, Alberta, Canada,Provincial Seniors Health and Continuing Care, Alberta Health
Services, Calgary, Alberta, Canada
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4
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Paskins Z, Babatunde O, Sturrock A, Toh LS, Horne R, Maidment I. Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance. Osteoporos Int 2022; 33:2245-2257. [PMID: 35688897 PMCID: PMC9568441 DOI: 10.1007/s00198-022-06453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/28/2022] [Indexed: 11/23/2022]
Abstract
Systematic reviews that examine effectiveness of interventions to improve medicines optimisation do not explain how or why they work. This realist review identified that interventions which effectively optimise medicines use in osteoporosis include opportunities to address patients' perceptions of illness and treatment and/or support primary care clinician decision making. INTRODUCTION In people with osteoporosis, adherence to medicines is poorer than other diseases and patients report follow-up is lacking, and multiple unmet information needs. We conducted a rapid realist review to understand what contextual conditions and mechanisms enable interventions to support osteoporosis medication optimisation. METHODS A primary search identified observational or interventional studies which aimed to improve medicines adherence or optimisation; a supplementary second search identified research of any design to gain additional insights on emerging findings. Extracted data was interrogated for patterns of context-mechanism-outcome configurations, further discussed in team meetings, informed by background literature and the Practicalities and Perception Approach as an underpinning conceptual framework. RESULTS We identified 5 contextual timepoints for the person with osteoporosis (identifying a problem; starting medicine; continuing medicine) and the practitioner and healthcare system (making a diagnosis and giving a treatment recommendation; reviewing medicine). Interventions which support patient-informed decision making appear to influence long-term commitment to treatment. Supporting patients' practical ability to adhere (e.g. by lowering treatment burden and issuing reminders) only appears to be helpful, when combined with other approaches to address patient beliefs and concerns. However, few studies explicitly addressed patients' perceptions of illness and treatment. Supporting primary care clinician decision making and integration of primary and secondary care services also appears to be important, in improving rates of treatment initiation and adherence. CONCLUSIONS We identified a need for further research to identify a sustainable, integrated, patient-centred, and cost- and clinically effective model of long-term care for people with osteoporosis.
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Affiliation(s)
- Z Paskins
- School of Medicine, Keele University, Keele, UK.
- Haywood Academic Rheumatology Centre, Stoke-on-Trent, Staffordshire, UK.
| | - O Babatunde
- School of Medicine, Keele University, Keele, UK
| | - A Sturrock
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - L S Toh
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - R Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - I Maidment
- Clinical Pharmacy, Aston University, Birmingham, UK
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5
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Saag JL, Danila MI. Remote Management of Osteoporosis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2022; 8:143-151. [PMID: 36068838 PMCID: PMC9438367 DOI: 10.1007/s40674-022-00195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review Osteoporosis management has evolved significantly over the past decade, with telehealth emerging as an effective tool to manage bone health in a growing patient population. This review explores the advantages and disadvantages of telehealth use for osteoporosis management while highlighting recent studies of clinical importance. Recent Findings A wide variety of telehealth approaches are used today, from phone or video telemedicine appointments with physicians and advanced practice providers, to electronic systems for triage and consultation with osteoporosis specialists. Contemporary studies show that telehealth can facilitate health care access to underserved communities and enhance physician–patient communication, as well as provide patient education. However, barriers such as inexperience or lack of access to technology, suboptimal patient-clinician relationship building process, and difficulties with follow-up have limited the use of telehealth to certain situations. Summary Telehealth has proven to be an effective resource for managing and treating osteoporosis patients. As its use continues to grow, important limitations must be accounted for to avoid lapses in care. Further research should keep these factors in mind as the use of this technology progresses.
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Affiliation(s)
- Jordan L. Saag
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827 USA
| | - Maria I. Danila
- Geriatric Research Education and Clinical Center (GRECC) Birmingham VA Medical Center, 700 19th St. S., Birmingham, AL 35233 USA
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6
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Qu H, Silverman SL, Shewchuk RM, Curtis JR, Austin S, Greenspan SL, Nieves JW, Outman RC, Warriner AH, Watts NB, Saag KG. Understanding Physicians’ Perceptions of Patient-Identified Barriers to Osteoporosis Medication Initiation: A Cognitive Mapping Approach. Risk Manag Healthc Policy 2022; 15:1293-1302. [PMID: 35818434 PMCID: PMC9270903 DOI: 10.2147/rmhp.s361559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/25/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Interventions to initiate medication and increase adherence for postmenopausal women who have had a fragility fracture were not always successful. The purpose of this study was to derive an empirical framework for patient-identified barriers to osteoporosis medication initiation and adherence from physician experts. Methods A cognitive mapping approach involving nominal group technique (NGT) meetings and a card sorting and rating task were used to obtain formative data. We first conducted four NGT meetings with 18 women patients who were not on osteoporosis treatment to identify barriers to osteoporosis medication, then invited 27 osteoporosis physicians to sort and rate 25 patients identified barriers. Descriptive analysis, multidimensional scaling analysis, and hierarchical cluster analysis were applied for data analysis. Results A two-dimensional five-cluster cognitive map was derived to provide an organizational framework for understanding patients perceived barriers to medication initiation and adherence. The five clusters were concerns about side effects, experience of side effects, lifestyle changes, medication access and complexity, and patient uncertainty about treatment and trust in the provider. The two dimensions were interpreted as internal to patients (X-axis) and external to patients (Y-axis). Conclusions/Implications Views of patients solicited in a structured format provided directions to help in designing interventions to improve osteoporosis medication initiation and adherence.
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Affiliation(s)
- Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
- Correspondence: Haiyan Qu, Department of Health Services Administration, University of Alabama at Birmingham, SHPB 580D, 1716 9th Ave. S., Birmingham, AL, 35294-1212, USA, Tel +1 205996-4940, Email
| | | | - Richard M Shewchuk
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey R Curtis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shamly Austin
- Research, Development, & Analytics, Highmark Wholecare, Pittsburgh, PA, USA
| | - Susan L Greenspan
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeri W Nieves
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Ryan C Outman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy H Warriner
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kenneth G Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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7
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Anastasilakis AD, Pepe J, Napoli N, Palermo A, Magopoulos C, Khan AA, Zillikens MC, Body JJ. Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS. J Clin Endocrinol Metab 2022; 107:1441-1460. [PMID: 34922381 PMCID: PMC9016445 DOI: 10.1210/clinem/dgab888] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Antiresorptive therapy significantly reduces fracture risk in patients with benign bone disease and skeletal-related events (SREs) in patients with bone metastases (BM). Osteonecrosis of the jaw (ONJ) is a rare but severe condition manifested as necrotic bone lesion or lesions of the jaws. ONJ has been linked to the use of potent antiresorptive agents, termed medication-related ONJ (MRONJ). OBJECTIVE We aimed to identify the differences various aspects of MRONJ among distinct patient categories and provide recommendations on how to mitigate the risk and optimally manage MRONJ in each of them. METHODS A working group of the European Calcified Tissue Society (ECTS) and 2 experts performed an updated detailed review of existing literature on MRONJ incidence, characteristics, and treatment applied in bone diseases with variable severity of skeletal insult, ranging from osteoporosis to prevention of cancer treatment-induced bone loss and SREs in cancer patients with BM. RESULTS The risk for MRONJ is much higher in patients with advanced malignancies compared to those with benign bone diseases because of the higher doses and more frequent administration of antiresorptive agents in individuals with compromised general health, along with coadministration of other medications that predispose to MRONJ. The overall risk for MRONJ is considerably lower than the benefits in all categories of patients. CONCLUSION The risk for MRONJ largely depends on the underlying bone disease and the relevant antiresorptive regimen applied. Physicians and dentists should keep in mind that the benefits of antiresorptive therapy far outweigh the risk for MRONJ development.
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Affiliation(s)
- Athanasios D Anastasilakis
- Department of Endocrinology, 424 General Military Hospital, 564 29 N Efkarpia Thessaloniki, Greece
- Correspondence: Athanasios D. Anastasilakis, PhD, Department of Endocrinology, 424 General Military Hospital, Ring Rd, 564 29 N Efkarpia, Thessaloniki, Greece.
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Christos Magopoulos
- Department of Oral and Maxillofacial Surgery, 424 General Military Hospital, 56429 Thessaloniki, Greece
| | - Aliya A Khan
- Division of Endocrinology and Metabolism and Geriatrics, McMaster University, L8N3Z5 Hamilton, Ontario, Canada
| | - M Carola Zillikens
- Bone Center, Department of Internal Medicine, Erasmus MC, 2040 Rotterdam, the Netherlands
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium
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8
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Gupta A, Maslen C, Vindlacheruvu M, Abel RL, Bhattacharya P, Bromiley PA, Clark EM, Compston JE, Crabtree N, Gregory JS, Kariki EP, Harvey NC, McCloskey E, Ward KA, Poole KE. Digital health interventions for osteoporosis and post-fragility fracture care. Ther Adv Musculoskelet Dis 2022; 14:1759720X221083523. [PMID: 35368375 PMCID: PMC8966117 DOI: 10.1177/1759720x221083523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The growing burden from osteoporosis and fragility fractures highlights a need to improve osteoporosis management across healthcare systems. Sub-optimal management of osteoporosis is an area suitable for digital health interventions. While fracture liaison services (FLSs) are proven to greatly improve care for people with osteoporosis, such services might benefit from technologies that enhance automation. The term 'Digital Health' covers a variety of different tools including clinical decision support systems, electronic medical record tools, patient decision aids, patient apps, education tools, and novel artificial intelligence (AI) algorithms. Within the scope of this review are AI solutions that use algorithms within health system registries to target interventions. Clinician-targeted, patient-targeted, or system-targeted digital health interventions could be used to improve management and prevent fragility fractures. This review was commissioned by The Royal Osteoporosis Society and Bone Research Academy during the production of the 2020 Research Roadmap (https://theros.org.uk), with the intention of identifying gaps where targeted research funding could lead to improved patient health. We explore potential uses of digital technology in the general management of osteoporosis. Evidence suggests that digital technologies can support multidisciplinary teams to provide the best possible patient care based on current evidence and to support patients in self-management. However, robust randomised controlled studies are still needed to assess the effectiveness and cost-effectiveness of these technologies.
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Affiliation(s)
- Amit Gupta
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | - Nicola Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | | | - Kenneth E.S. Poole
- University of Cambridge School of Clinical Medicine, CB2 0QQ Cambridge, UK
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9
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Adami G, Fassio A, Gatti D, Viapiana O, Benini C, Danila MI, Saag KG, Rossini M. Osteoporosis in 10 years time: a glimpse into the future of osteoporosis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221083541. [PMID: 35342458 PMCID: PMC8941690 DOI: 10.1177/1759720x221083541] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 12/21/2022] Open
Abstract
Patients living with osteoporosis are projected to increase dramatically in the
next decade. Alongside the forecasted increased societal and economic burden, we
will live a crisis of fractures. However, we will have novel pharmacological
treatment to face this crisis and, more importantly, new optimized treatment
strategies. Fracture liaison services will be probably implemented on a large
scale worldwide, helping to prevent additional fractures in high-risk patients.
In the next decade, novel advances in the diagnostic tools will be largely
available. Moreover, new and more precise fracture risk assessment tools will
change our ability to detect patients at high risk of fractures. Finally, big
data and artificial intelligence will help us to move forward into the world of
precision medicine. In the present review, we will discuss the future
epidemiology and costs of osteoporosis, the advances in early and accurate
diagnosis of osteoporosis, with a special focus on biomarkers and imaging tools.
Then we will examine new and refined fracture risk assessment tools, the role of
fracture liaison services, and a future perspective on osteoporosis
treatment.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, University of Verona, Pz Scuro 10, 37134 Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | | | - Maria I. Danila
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
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10
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Prior JC, Oei EHG, Brown JP, Oei L, Koromani F, Lentle BC. Where's the break? Critique of radiographic vertebral fracture diagnostic methods. Osteoporos Int 2021; 32:2391-2395. [PMID: 34674023 PMCID: PMC8608772 DOI: 10.1007/s00198-021-06207-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Affiliation(s)
- J C Prior
- BC Centre of the Canadian Multicentre Osteoporosis Study (CaMos), Vancouver, Canada.
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
- BC Women's Health Research Institute, Vancouver, Canada.
- Endocrinology and Metabolism, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - E H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - J P Brown
- Infectious and Immune Diseases Axis, CHU de Québec Research Centre, Quebec City, Canada
- Department of Medicine, Division of Rheumatology, Laval University, Quebec City, Canada
| | - L Oei
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Van Weel-Bethesda Hospital, Dirksland, The Netherlands
- Department of Internal Medicine, Jan Van Goyen Medical Center, Amsterdam, The Netherlands
| | - F Koromani
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Brian C Lentle
- BC Centre of the Canadian Multicentre Osteoporosis Study (CaMos), Vancouver, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
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11
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Van Tiem JM, Steffen MJA, Seaman AT, Miller K, Wardyn SE, Richards CC, Solimeo SL. Attitudes toward bone health among rural-dwelling veterans identified as at risk of fracture: a qualitative analysis. JBMR Plus 2021; 5:e10501. [PMID: 34189387 PMCID: PMC8216131 DOI: 10.1002/jbm4.10501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 01/02/2023] Open
Abstract
Although much is known about system‐level barriers to prevention and treatment of bone health problems, little is known about patient‐level barriers. The objective of this study was to identify factors limiting engagement in bone health care from the perspective of rural‐dwelling patients with known untreated risk. Over 6 months, 39 patients completed a qualitative interview. Interview questions focused on the patient's experience of care, their decision to not accept care, as well as their knowledge of osteoporosis and the impact it has had on their lives. Participants were well‐informed and could adequately describe osteoporosis and its deleterious effects, and their decision making around accepting or declining a dual‐energy x‐ray absorptiometry (DXA) scan and treatment was both cautious and intentional. Decisions about how to engage in treatment were tempered by expectations for quality of life. Our findings suggest that people hold beliefs about bone health treatment that we can build on. Work to improve care of this population needs to recognize that bone health providers are not adding a behavior of medication taking to patients, they are changing a behavior or belief. Published 2021. This article is a U.S. Government work and is in the public domain in the USA. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jennifer M Van Tiem
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA
| | - Melissa J A Steffen
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA
| | - Aaron T Seaman
- VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA.,Department of Internal Medicine Carver College of Medicine, University of Iowa Iowa City Iowa USA
| | - Karla Miller
- Department of Medicine Salt Lake City VA Health Care System Salt Lake City Utah USA.,Division of Rheumatology University of Utah School of Medicine Salt Lake City Utah USA
| | - Shylo E Wardyn
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA
| | - Christopher C Richards
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA
| | - Samantha L Solimeo
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA.,Department of Internal Medicine Carver College of Medicine, University of Iowa Iowa City Iowa USA
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12
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Dalle Carbonare L, Mottes M, Valenti MT. Medication-Related Osteonecrosis of the Jaw (MRONJ): Are Antiresorptive Drugs the Main Culprits or Only Accomplices? The Triggering Role of Vitamin D Deficiency. Nutrients 2021; 13:561. [PMID: 33567797 PMCID: PMC7915474 DOI: 10.3390/nu13020561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/20/2023] Open
Abstract
Osteonecrosis of the jaw (ONJ) is a severe clinical condition characterized mostly but not exclusively by an area of exposed bone in the mandible and/or maxilla that typically does not heal over a period of 6-8 weeks. The diagnosis is first of all clinical, but an imaging feedback such as Magnetic Resonance is essential to confirm clinical suspicions. In the last few decades, medication-related osteonecrosis of the jaw (MRONJ) has been widely discussed. From the first case reported in 2003, many case series and reviews have appeared in the scientific literature. Almost all papers concerning this topic conclude that bisphosphonates (BPs) can induce this severe clinical condition, particularly in cancer patients. Nevertheless, the exact mechanism by which amino-BPs would be responsible for ONJ is still debatable. Recent findings suggest a possible alternative explanation for BPs role in this pattern. In the present work we discuss how a condition of osteomalacia and low vitamin D levels might be determinant factors.
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Affiliation(s)
- Luca Dalle Carbonare
- Department of Medicine, Section of Internal Medicine, University of Verona, 37134 Verona, Italy;
| | - Monica Mottes
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Biology and Genetics, University of Verona, 37134 Verona, Italy;
| | - Maria Teresa Valenti
- Department of Medicine, Section of Internal Medicine, University of Verona, 37134 Verona, Italy;
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13
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Miller MJ, Jou T, Danila MI, Mudano AS, Rahn EJ, Outman RC, Saag KG. Use of path modeling to inform a clinical decision support application to encourage osteoporosis medication use. Res Social Adm Pharm 2020; 17:1267-1275. [PMID: 33011082 DOI: 10.1016/j.sapharm.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Osteoporosis medication use is suboptimal. Simple interventions personalized to a patients' stage of readiness are needed to encourage osteoporosis medication use. OBJECTIVES To estimate interrelationships of sociodemographic factors, perceived fracture risk, health literacy, receipt of medication information, medication trust and readiness to use osteoporosis medication; and apply observed relationships to inform design specifications for a clinical decision support application that can be used for personalized patient counseling. METHODS Data from a national sample of older women (n = 1759) with self-reported history of fractures and no current use of osteoporosis medication treatment were used to estimate an acceptable path model that describes associations among key sociodemographic characteristics, health literacy, perceived fracture risk, receipt of osteoporosis medication information within the past year, trust in osteoporosis medications, and readiness to use osteoporosis medication. Path model results were used to inform an application for personalized patient counseling that can be easily integrated into clinical decision support systems. RESULTS Increased age (β = 0.13), trust for medications (β = 0.12), higher perceived fracture risk (β = 0.21), and having received medication information within the past year (β = 0.21) were all positively associated with readiness to use osteoporosis medication (p < 0.0001). Whereas, health literacy (β = -0.09) was inversely associated with readiness to use osteoporosis medication (p < 0.0001). Using these results, a brief 6-item question set was constructed for simple integration into clinical decision support applications. Patient responses were used to inform a provider dashboard that integrates a patient's stage of readiness for osteoporosis medication use, predictors of readiness, and personalized counseling points appropriate to their stage of readiness. CONCLUSION Content of counseling strategies must be aligned with a patient's stage of readiness to use treatment. Path modeling can be effectively used to identify factors for inclusion in an evidenced-based clinical decision support application designed to assist providers with personalized patient counseling and osteoporosis medication use decisions.
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Affiliation(s)
- Michael J Miller
- Mid-Atlantic Permanente Research Institute (MAPRI), 2101 East Jefferson Street, Rockville, MD, 20852, USA.
| | - Tzuchen Jou
- PGY1 Pharmacy Resident, Memorial Hermann Southwest Hospital, Houston, TX, 77074, USA.
| | - Maria I Danila
- Medicine - Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-2182, USA.
| | - Amy S Mudano
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-2182, USA.
| | - Elizabeth J Rahn
- Department of Medical Education, University of Alabama at Birmingham, Birmingham, AL, 35294-2182, USA.
| | - Ryan C Outman
- Division of Hematology and Oncology, UAB Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-2182, USA.
| | - Kenneth G Saag
- Medicine - Immunology and Rheumatology, Vice Chair, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-2182, USA.
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14
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Linton DN, Porteous J, Eatson H, Chepesiuk R, Long T, Inrig TM, Frankel L, Jain R, Sale JEM. Educational booklet reinforces knowledge of osteoporosis and influences intentions to improve bone health in previously diagnosed and treated patients. Osteoporos Int 2020; 31:1703-1711. [PMID: 32333065 DOI: 10.1007/s00198-020-05392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED We examined individuals' experiences using an educational booklet developed by the Ontario Osteoporosis Strategy. The booklet appeared to motivate individuals to make changes to their existing management of their bone health and served as a reference tool reaffirming current practices and beliefs for others. INTRODUCTION The purpose of this study was to examine individuals' experiences of the educational booklet and explore the influence of the booklet on individuals' beliefs and actions regarding their bone health. METHODS Eligible individuals were those who had been prescribed medication to treat low bone mass. One-on-one telephone interviews were conducted over an 18-month period. Participants were interviewed for approximately 1 hour and asked to provide their feedback on the booklet, and to discuss what they were doing with respect to the recommendations made in the booklet. RESULTS We interviewed 50 participants who ranged in age from 58 to 89. The overall impression of the booklet was positive. Participants described the language in the booklet as clear and easy to understand. Participants stated that they would have appreciated receiving this tool at the onset of their diagnosis. Forty-two participants had already taken action, or expressed an intention to make changes, to their existing routines to improve their bone health. In contrast, eight participants used the booklet to reaffirm current practices and beliefs. For these individuals, the recommendations made in the booklet were consistent with what they had already been doing. CONCLUSION The booklet can engage patients in discussions about bone health. The booklet appeared to motivate individuals to make changes to their existing routines in an effort to achieve better health outcomes for their bone health. Providing a tool like this to people recently diagnosed with a bone health issue may prove to be beneficial.
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Affiliation(s)
- D N Linton
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - J Porteous
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - H Eatson
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - R Chepesiuk
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - T Long
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - T M Inrig
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - L Frankel
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - R Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - J E M Sale
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada
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15
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Cornelissen D, de Kunder S, Si L, Reginster JY, Evers S, Boonen A, Hiligsmann M. Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review. Osteoporos Int 2020; 31:1645-1669. [PMID: 32358684 PMCID: PMC7423788 DOI: 10.1007/s00198-020-05378-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/04/2020] [Indexed: 01/25/2023]
Abstract
UNLABELLED An earlier systematic review on interventions to improve adherence and persistence was updated. Fifteen studies investigating the effectiveness of patient education, drug regimen, monitoring and supervision, and interdisciplinary collaboration as a single or multi-component intervention were appraised. Multicomponent interventions with active patient involvement were more effective. INTRODUCTION This study was conducted to update a systematic literature review on interventions to improve adherence to anti-osteoporosis medications. METHODS A systematic literature review was carried out in Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov , NHS Centre for Review and Dissemination, CINHAL, and PsycINFO to search for original studies that assessed interventions to improve adherence (comprising initiation, implementation, and discontinuation) and persistence to anti-osteoporosis medications among patients with osteoporosis, published between July 2012 and December 2018. Quality of included studies was assessed. RESULTS Of 585 studies initially identified, 15 studies fulfilled the inclusion criteria of which 12 were randomized controlled trials. Interventions were classified as (1) patient education (n = 9), (2) drug regimen (n = 3), (3) monitoring and supervision (n = 2), and (4) interdisciplinary collaboration (n = 1). In most subtypes of interventions, mixed results on adherence (and persistence) were found. Multicomponent interventions based on patient education and counseling were the most effective interventions when aiming to increase adherence and/or persistence to osteoporosis medications. CONCLUSION This updated review suggests that patient education, monitoring and supervision, change in drug regimen, and interdisciplinary collaboration have mixed results on medication adherence and persistence, with more positive effects for multicomponent interventions with active patient involvement. Compared with the previous review, a shift towards more patient involvement, counseling and shared decision-making, was seen, suggesting that individualized solutions, based on collaboration between the patient and the healthcare provider, are needed to improve adherence and persistence to osteoporosis medications.
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Affiliation(s)
- D Cornelissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands.
| | - S de Kunder
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - L Si
- The George Institute for Global Health, UNSW Sydney, Kensington, Australia
| | - J-Y Reginster
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - S Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
- Centre for economic evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - A Boonen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
- Department of Internal Medicine, Rheumatology, Maastricht University Medical Centre and CAPHRI, Maastricht University, Maastricht, Netherlands
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
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16
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Adami G, Saag KG, Mudano AS, Rahn EJ, Wright NC, Outman RC, Greenspan SL, LaCroix AZ, Nieves JW, Silverman SL, Siris ES, Watts NB, Miller MJ, Ladores S, Curtis JR, Danila MI. Factors associated with the contemplative stage of readiness to initiate osteoporosis treatment. Osteoporos Int 2020; 31:1283-1290. [PMID: 32020264 PMCID: PMC7365553 DOI: 10.1007/s00198-020-05312-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/22/2020] [Indexed: 02/02/2023]
Abstract
UNLABELLED We investigated the factors associated with readiness for initiating osteoporosis treatment in women at high risk of fracture. We found that women in the contemplative stage were more likely to report previously being told having osteoporosis or osteopenia, acknowledge concern about osteoporosis, and disclose prior osteoporosis treatment. INTRODUCTION Understanding factors associated with reaching the contemplative stage of readiness to initiate osteoporosis treatment may inform the design of behavioral interventions to improve osteoporosis treatment uptake in women at high risk for fracture. METHODS We measured readiness to initiate osteoporosis treatment using a modified form of the Weinstein Precaution Adoption Process Model (PAPM) among 2684 women at high risk of fracture from the Activating Patients at Risk for OsteoPOroSis (APROPOS) clinical trial. Pre-contemplative participants were those who self-classified in the unaware and unengaged stages of PAPM (stages 1 and 2). Contemplative participants were those in the undecided, decided not to act, or decided to act stages of PAPM (stages 3, 4, and 5). Using multivariable logistic regression, we evaluated participant characteristics associated with levels of readiness to initiate osteoporosis treatment. RESULTS Overall, 24% (N = 412) self-classified in the contemplative stage of readiness to initiate osteoporosis treatment. After adjusting for age, race, education, health literacy, and major osteoporotic fracture in the past 12 months, contemplative women were more likely to report previously being told they had osteoporosis or osteopenia (adjusted odds ratio [aOR] (95% CI) 11.8 (7.8-17.9) and 3.8 (2.5-5.6), respectively), acknowledge concern about osteoporosis (aOR 3.5 (2.5-4.9)), and disclose prior osteoporosis treatment (aOR 4.5 (3.3-6.3)) than women who self-classified as pre-contemplative. CONCLUSIONS For women at high risk for future fractures, ensuring women's recognition of their diagnosis of osteoporosis/osteopenia and addressing their concerns about osteoporosis are critical components to consider when attempting to influence stage of behavior transitions in osteoporosis treatment.
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Affiliation(s)
- G Adami
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA
- Rheumatology Unit, University of Verona, Verona, Italy
| | - K G Saag
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - A S Mudano
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - E J Rahn
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - N C Wright
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - R C Outman
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - S L Greenspan
- University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - A Z LaCroix
- Group Health Cooperative, Seattle, WA, 98112, USA
- University of California San Diego, La Jolla, CA, 92093, USA
| | - J W Nieves
- Helen Hayes Hospital, West Haverstraw, NY, 10993, USA
| | - S L Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, 30211, USA
| | - E S Siris
- Columbia University Medical Center, New York, NY, 10032, USA
| | - N B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, 45236, USA
| | - M J Miller
- Texas A&M University, College Station, TX, 77843, USA
- Kaiser Permanente, Rockville, MD, 20852, USA
| | - S Ladores
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - J R Curtis
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - M I Danila
- University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
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17
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Beaupre LA, Moradi F, Khong H, Smith C, Evens L, Hanson HM, Juby AG, Kivi P, Majumdar SR. Implementation of an in-patient hip fracture liaison services to improve initiation of osteoporosis medication use within 1-year of hip fracture: a population-based time series analysis using the RE-AIM framework. Arch Osteoporos 2020; 15:83. [PMID: 32488730 DOI: 10.1007/s11657-020-00751-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/05/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED A hip fracture liaison service that was implemented in 2 hospitals in Alberta, Canada, co-managed by a nurse and physician, was effective for improving initiation of osteoporosis medication following hip fracture. PURPOSE To examine implementation of an in-patient hip fracture liaison service (H-FLS) to improve osteoporosis medication use after hip fracture using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance). METHODS Using population-based administrative data from 7 quarters before and up to 7 quarters after H-FLS implementation, we examined new starts, continued use, and overall use (new starts + continued use) of osteoporosis medication after hip fracture. A total of 1427 patients 50 years and older that underwent hip fracture surgery at 1 of 2 tertiary hospitals in a Canadian province and survived to 12 months post-fracture were included. We also compared treatment initiation rates by sex and hospital. RESULTS Of the 1427 patients, 1002 (70.2%) were female (mean age = 79.3 ± 11.9 years) and 425 (29.8%) were male (mean age = 73.8 ± 13.8 years). Based on pre-fracture residence within the health zone, 1101 (69%) were considered eligible (Reach). New starts of osteoporosis medication increased from 24.7% pre- to 43.9% post-implementation of the H-FLS (p < 0.001) (effectiveness). The proportion of patients prescribed osteoporosis medication prior to a hip fracture remained consistent (15.1% pre-; 14.7% post-implementation; p = 0.88) with a resultant improvement in overall medication use from 39.8% pre- to 58.6% post-implementation (p < 0.001). Both sites significantly improved medication initiation (site 1: 27.9% pre- to 40.3% post-implementation; site 2: 19.6% pre- to 50.0% post-implementation; p < 0.001 for both) (adoption). Medication initiation in females improved from 26.0% pre- to 43.4% post-implementation while initiation in males improved from 21.7% pre- to 45.1% post-implementation (p < 0.001[females]; p = 0.001[males]) (implementation). Post-implementation, elevated initiation rates were retained over the 7 quarters (p = 0.81) (maintenance). CONCLUSIONS An H-FLS based in two tertiary hospital sites significantly improved use of osteoporosis medications after hip fracture in both males and females.
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Affiliation(s)
- L A Beaupre
- University of Alberta (Physical Therapy), 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - F Moradi
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - H Khong
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - C Smith
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - L Evens
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - H M Hanson
- Seniors Health Strategic Clinical Network™, Alberta Health Services and University of Calgary (Medicine), Calgary, AB, Canada
| | - A G Juby
- University of Alberta (Geriatric Medicine), Edmonton, AB, Canada
| | - P Kivi
- University of Alberta (Family Medicine), Edmonton, AB, Canada
| | - S R Majumdar
- University of Alberta (Medicine), Edmonton, AB, Canada
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18
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Botelho J, Machado V, Proença L, Delgado AS, Mendes JJ. Vitamin D Deficiency and Oral Health: A Comprehensive Review. Nutrients 2020; 12:E1471. [PMID: 32438644 PMCID: PMC7285165 DOI: 10.3390/nu12051471] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
Vitamin D (VD) levels have been gaining growing attention in Oral Health. During growth and adulthood, VD deficiency (VDD) is associated with a wide variety of oral health disorders, and impaired VD synthesis may expedite some of these conditions. In children, severe VDD can induce defective tooth mineralization, resulting in dentin and enamel defects. As a consequence, these defects may increase the risk of the onset and progression of dental caries. Further, VDD has been associated with higher prevalence of periodontitis and gingival inflammation, and several recent preclinical and clinical studies have unveiled potential pathways through which Vitamin D may interact with the periodontium. VDD correction through supplementation may contribute to a successful treatment of periodontitis; however, alveolar bone regeneration procedures performed in baseline VDD patients seem more prone to failure. Vitamin D may also be linked with some oral pathology entities such as certain oral cancers and events of osteonecrosis of the jaw. This review aims to provide comprehensive evidence of how VD levels should be considered to promote good oral health, and to summarize how VDD may hamper oral development and its role in certain oral conditions.
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Affiliation(s)
- João Botelho
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal;
- CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal; (A.S.D.); (J.J.M.)
| | - Vanessa Machado
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal;
- CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal; (A.S.D.); (J.J.M.)
- Orthodontics Department, CRU, CiiEM, Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal
| | - Luís Proença
- Quantitative Methods for Health Research Unit (MQIS), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal;
| | - Ana Sintra Delgado
- CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal; (A.S.D.); (J.J.M.)
- Orthodontics Department, CRU, CiiEM, Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal
| | - José João Mendes
- CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Almada, Portugal; (A.S.D.); (J.J.M.)
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19
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Billington EO, Feasel AL, Kline GA. At Odds About the Odds: Women's Choices to Accept Osteoporosis Medications Do Not Closely Agree with Physician-Set Treatment Thresholds. J Gen Intern Med 2020; 35:276-282. [PMID: 31625042 PMCID: PMC6957614 DOI: 10.1007/s11606-019-05384-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/22/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Osteoporosis guidelines recommend pharmacologic therapy based on 10-year risk of major osteoporotic fracture (MOF) and hip fracture, which may fail to account for patient-specific experiences and values. OBJECTIVE We aimed to determine whether patient decisions to initiate osteoporosis medication agree with guideline-recommended intervention thresholds. DESIGN AND PARTICIPANTS This prospective cohort study included women aged ≥ 45 with age-associated osteoporosis who attended a group osteoporosis self-management consultation at a tertiary osteoporosis center. INTERVENTION A group osteoporosis self-management consultation, during which participants received osteoporosis education and then calculated1 their 10-year MOF and hip fracture risk using FRAX and2 their predicted absolute fracture risk with therapy (assuming 40% relative reduction). Participants then made autonomous decisions regarding treatment initiation. MAIN MEASURES We evaluated agreement between treatment decisions and physician-set intervention thresholds (10-year MOF risk ≥ 20%, hip fracture risk ≥ 3%). KEY RESULTS Among 85 women (median [IQR] age 62 [58-67]), 27% accepted treatment (median [IQR] MOF risk, 15.1% [9.9-22.0]; hip fracture risk, 3.3% [1.3-5.3]), 46% declined (MOF risk, 9.5% [6.5-11.6]; hip fracture risk, 1.8% [0.6-2.3]), and 27% remained undecided (MOF risk, 14.0% [9.8-20.2]; hip fracture risk, 4.4% [1.7-4.9]). There was wide overlap in fracture risk between treatment acceptors and non-acceptors. Odds of accepting treatment were higher in women with prior fragility fracture (50% accepted; OR, 5.3; 95% CI, 1.9-15.2; p = 0.0015) and with hip fracture risk ≥ 3% (32% accepted; OR, 3.6; 95% CI, 1.4-9.2; p = 0.012), but not MOF risk ≥ 20% (47% accepted; OR, 3.0; 95% CI, 1.0-8.5; p = 0.105). CONCLUSIONS Informed decisions to start osteoporosis treatment are highly personal and not easily predicted using fracture risk. Guideline-recommended intervention thresholds may not permit sufficient consideration of patient preferences.
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Affiliation(s)
- Emma O Billington
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada.
| | - A Lynn Feasel
- Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Gregory A Kline
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada
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20
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Xie C, Mu X, Hu Z, Wang W, Huang W, Huang G, Wang C, Yin D. Impact of pharmaceutical care in the orthopaedic department. J Clin Pharm Ther 2019; 45:401-407. [PMID: 31800132 DOI: 10.1111/jcpt.13091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE In the mid-1960s, clinical pharmacy developed in the USA, and as the demand for pharmaceutical services continued to grow, their impact began to be taken seriously. However, the participation of clinical pharmacists as members of the multidisciplinary team in the orthopaedic department is still in its infancy, although its role in orthopaedics has not been defined. The object of this study was to identify and discuss the impact of pharmaceutical care in the orthopaedic department. METHODS A literature search was conducted on MEDLINE, PubMed, Web of Science, the Cochrane Library and CNKI (China National Knowledge Infrastructure) for papers published between 1998 and 2019, using the keywords pharmacy, pharmacist, and medication or drug combined with orthopaedic. Other available resources were also used to identify relevant articles. RESULTS AND DISCUSSION Based on the available evidence in 74 articles, it was found that clinical pharmacists play an important role in all aspects of rational use of medications, medication review and reconciliation, monitoring adverse drug events, risk assessment, and medication education and counselling. In addition, clinical pharmacy services were developed to minimize medication errors, adverse drug events and medical costs, but clinical pharmacy is still in its early stages in orthopaedics. WHAT IS NEW AND CONCLUSION A multidisciplinary approach should be adopted in the orthopaedic department, as pharmacist interventions can be vital for promoting the safety, effectiveness and cost-effectiveness of pharmacotherapy. Although pharmacists' contributions to orthopaedics are not yet fully recognized, pharmaceutical services can undoubtedly contribute to both clinical and societal outcomes.
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Affiliation(s)
- Chengxin Xie
- Faculty of Graduate Studies, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaoping Mu
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhuangming Hu
- Faculty of Nursing, Guangxi University of Chinese Medicine, Nanning, China
| | - Wei Wang
- Faculty of Graduate Studies, Guangxi University of Chinese Medicine, Nanning, China
| | - Wenwen Huang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ge Huang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chenglong Wang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Dong Yin
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Abstract
PURPOSE OF REVIEW The aims of this review are to summarize current performance for osteoporosis quality measures used by Centers for Medicare and Medicaid (CMS) for pay-for-performance programs and to describe recent quality improvement strategies around these measures. RECENT FINDINGS Healthcare Effectiveness Data and Information (HEDIS) quality measures for the managed care population indicate gradual improvement in osteoporosis screening, osteoporosis identification and treatment following fragility fracture, and documentation of fall risk assessment and plan of care between 2006 and 2016. However, population-based studies suggest achievement for these process measures is lower where reporting is not mandated. Performance gaps remain, particularly for post-fracture care. Elderly patients with increased comorbidity are especially vulnerable to fractures, yet underperformance is documented in this population. Gender and racial disparities also exist. As has been shown for other areas of health care, education alone has a limited role as a quality improvement intervention. Multifactorial and systems-based interventions seem to be most successful in leading to measurable change for osteoporosis care and fall prevention. Despite increasing recognition of evidence-based quality measures for osteoporosis and incentives to improve upon performance for these measures, persistent gaps in care exist that will require further investigation into sustainable and value-adding quality improvement interventions.
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Affiliation(s)
- S French
- Division of Rheumatology, Department of Medicine, University of California, 4150 Clement St, Rm 111R, San Francisco, CA, 94121, USA
| | - S Choden
- Division of Rheumatology, Department of Medicine, University of California, 4150 Clement St, Rm 111R, San Francisco, CA, 94121, USA
| | - Gabriela Schmajuk
- Division of Rheumatology, Department of Medicine, University of California, 4150 Clement St, Rm 111R, San Francisco, CA, 94121, USA.
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
- Rheumatology Section, Medical Service, San Francisco VA Hospital, San Francisco, CA, USA.
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Mo J, Huang K, Wang X, Sheng X, Wang Q, Fang X, Fan S. The Sensitivity of Orthopaedic Surgeons to the Secondary Prevention of Fragility Fractures. J Bone Joint Surg Am 2018; 100:e153. [PMID: 30562300 DOI: 10.2106/jbjs.17.01297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Orthopaedic surgeons must play an important role in the secondary prevention of fragility fractures; however, some surgeons are more aware than others of their responsibility regarding fracture prevention. The purpose of the present study was to identify which factors can lead to a higher sensitivity for fracture prevention. METHODS A cross-sectional survey was distributed to orthopaedic surgeons via online invitation or at academic conferences in China from July through October 2015. A total of 452 surgeons responded. As the primary outcome measure, we created a sensitivity scoring system for fracture prevention based on the respondents' answers to 5 questions regarding behavior in the following areas: risk-factor evaluation, pharmacologic therapy, nonpharmacologic therapy, patient education, and follow-up. Multivariable linear regression and multivariable logistic regression analyses were used to identify factors related to surgeon sensitivity to fracture prevention. RESULTS Very few surgeons reported having received adequate training regarding fracture prevention or reading guidelines or other fracture prevention literature (22% and 30%, respectively). Most respondents initiated pharmacologic or nonpharmacologic therapy (82% and 75%, respectively) for the treatment of confirmed osteoporosis among patients with fragility fractures, but only half performed a risk-factor evaluation, patient education, or timely patient follow-up (51%, 52%, and 48%, respectively). In the multivariable linear regression model, the orthopaedic surgeon's age (β = 0.09, p = 0.003), self-rated knowledge level regarding osteoporosis or related issues (β = 0.16, p < 0.001), self-perceived effectiveness in using preventive measures for patients with a fragility fracture (β = 0.62, p < 0.001), and use of clinical pathways for fragility fractures in his or her workplace (β = 1.24, p < 0.001) were independently associated with sensitivity scores for fracture prevention. Similar results were obtained from a multivariable logistic regression model. CONCLUSIONS In China, the sensitivity of orthopaedic surgeons to the secondary prevention of fragility fractures is relatively low. Implementation of a comprehensive prevention approach and targeted continuing medical education are required to encourage surgeons to take greater responsibility for screening, treating, educating, and following their patients with fragility fractures.
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Affiliation(s)
- Jian Mo
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.,Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People's Republic of China
| | - Kangmao Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xumeng Wang
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xinyu Sheng
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qiang Wang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiangqian Fang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
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Affiliation(s)
- Bo Abrahamsen
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark.,Department of Clinical Research, OPEN, University of Southern Denmark, Odense, Denmark
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