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Beaudart C, Sharma M, Clark P, Fujiwara S, Adachi JD, Messina OD, Morin SN, Kohlmeier LA, Sangan CB, Nogues X, Cruz-Priego GA, Cavallo A, Cooper F, Grier J, Leckie C, Montiel-Ojeda D, Papaioannou A, Raskin N, Yurquina L, Wall M, Bruyère O, Boonen A, Dennison E, Harvey NC, Kanis JA, Kaux JF, Lewiecki EM, Lopez-Borbon O, Paskins Z, Reginster JY, Silverman S, Hiligsmann M. Patients' preferences for fracture risk communication: the Risk Communication in Osteoporosis (RICO) study. Osteoporos Int 2024; 35:451-468. [PMID: 37955683 PMCID: PMC10866759 DOI: 10.1007/s00198-023-06955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it. Patients globally preferred a visual presentation of fracture risk and were interested in an online tool showing the risk. PURPOSE The aim of the Risk Communication in Osteoporosis (RICO) study was to assess patients' preferences regarding fracture risk communication. METHODS To assess patients' preferences for fracture risk communication, structured interviews with women with osteoporosis or who were at risk for fracture were conducted in 11 sites around the world, namely in Argentina, Belgium, Canada at Hamilton and with participants from the Osteoporosis Canada Canadian Osteoporosis Patient Network (COPN), Japan, Mexico, Spain, the Netherlands, the UK, and the USA in California and Washington state. The interviews used to collect data were designed on the basis of a systematic review and a qualitative pilot study involving 26 participants at risk of fracture. RESULTS A total of 332 women (mean age 67.5 ± 8.0 years, 48% with a history of fracture) were included in the study. Although the participants considered it important to receive information about their fracture risk (mean importance of 6.2 ± 1.4 on a 7-point Likert scale), only 56% (i.e. 185/332) had already received such information. Globally, participants preferred a visual presentation with a traffic-light type of coloured graph of their FRAX® fracture risk probability, compared to a verbal or written presentation. Almost all participants considered it important to discuss their fracture risk and the consequences of fractures with their healthcare professionals in addition to receiving information in a printed format or access to an online website showing their fracture risk. CONCLUSIONS There is a significant communication gap between healthcare professionals and patients when discussing osteoporosis fracture risk. The RICO study provides insight into preferred approaches to rectify this communication gap.
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Affiliation(s)
- Charlotte Beaudart
- Department of Health Services Research, Care & Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium.
| | | | - Patricia Clark
- Clinical Epidemiology Unit, Children's Hospital of Mexico, Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | | | - Osvaldo D Messina
- Investigaciones Reumatológicas y Osteológicas (IRO), Collaborating Centre WHO, Buenos Aires, Argentina
- IRO Medical Center, Investigaciones Reumatologicas y Osteologicas SRL, Buenos Aires, Argentina
| | | | | | | | - Xavier Nogues
- Internal Medicine Department, CIBERFES (ISCIII), Hospital del Mar Medical Research Institute, Pompeu Fabra University, Barcelona, Spain
| | - Griselda Adriana Cruz-Priego
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico, Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Andrea Cavallo
- Investigaciones Reumatológicas y Osteológicas (IRO), Collaborating Centre WHO, Buenos Aires, Argentina
| | | | | | | | - Diana Montiel-Ojeda
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico, Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | | | - Nele Raskin
- Department of Health Services Research, Care & Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Michelle Wall
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Olivier Bruyère
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Annelies Boonen
- Department of Health Services Research, Care & Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine and Sport Traumatology Department, University Hospital of Liège, Liège, Belgium
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - Oscar Lopez-Borbon
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
| | - Zoé Paskins
- School of Medicine, Keele University, Stoke-On-Trent, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke-On-Trent, UK
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Stuart Silverman
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care & Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Launois R, Cabout E, Benamouzig D, Velpry L, Briot K, Alliot F, Perrin L, Grange L, Sellami R, Touboul C, Joubert JM, Roux C. Barriers and Expectations for Patients in Post-Osteoporotic Fracture Care in France: The EFFEL Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:571-581. [PMID: 35365301 DOI: 10.1016/j.jval.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/12/2021] [Accepted: 10/10/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to quantify the relative importance of barriers to better secondary prevention of osteoporotic fractures and of care expectations expressed by patients with osteoporotic fractures in France. METHODS A qualitative exploration of potential barriers to care and expectations was undertaken through a systematic literature review and in-depth patients interviews. A list of 21 barriers and 21 expectations was identified. These were presented to 324 subjects with osteoporotic fractures, identified in a representative sample of the French population, in the form of best-worst scaling questionnaires. Patients rated the relative importance of the attributes, and arithmetic mean importance scores were calculated and ranked. A Bayesian hierarchical model was also performed to generate a relative importance score. Latent class analysis was performed to identify potential subgroups of patients with different response profiles. RESULTS A total of 7 barriers were rated as the most important, relating to awareness of osteoporosis and coordination of care. The highest-ranked barrier, "my fracture is not related to osteoporosis," was significantly more important than all the others (mean importance score 0.45; 95% confidence interval 0.33-0.56). A similar ranking of attributes was obtained with both the arithmetic and the Bayesian approach. For expectations, no clear hierarchy of attributes was identified. Latent class analysis discriminated 3 classes of respondents with significant differences in response profiles (the educated environmentalists, the unaware, and the victims of the system). CONCLUSIONS Better quality of care of osteoporosis and effective secondary fracture prevention will require improvements in patient education, training of healthcare professionals, and coordination of care.
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Affiliation(s)
| | - Elise Cabout
- Health Economic Assessment Network, Paris, France
| | - Daniel Benamouzig
- French National Center for Scientific Research, Paris, France; Sciences Po, Center of the Sociology of Organizations, Paris, France
| | - Livia Velpry
- Sociology and Anthropology Department, Paris 8 University, Paris, France
| | - Karine Briot
- Rhumatology Department, Cochin Hospital, Paris, France
| | | | | | - Laurent Grange
- Rhumatology Department, Grenobles Alpes University Hospital, Echirolles, France
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3
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Sale JEM, Gignac M, Frankel L, Thielke S, Bogoch E, Elliot-Gibson V, Hawker G, Funnell L. Perspectives of patients with depression and chronic pain about bone health after a fragility fracture: A qualitative study. Health Expect 2021; 25:177-190. [PMID: 34580957 PMCID: PMC8849261 DOI: 10.1111/hex.13361] [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] [Received: 01/23/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 11/05/2022] Open
Abstract
Background Compromised bone health is often associated with depression and chronic pain. Objective To examine: (1) the experience of existing depression and chronic nonfracture pain in patients with a fragility fracture; and (2) the effects of the fracture on depression and pain. Design A phenomenological study guided by Giorgi's analytical procedures. Setting and Participants Fracture patients who reported taking prescription medication for one or more comorbidities, excluding compromised bone health. Main Variables Studied Patients were interviewed within 6 weeks of their fracture, and 1 year later. Interview questions addressed the recent fracture and patients' experience with bone health and their other health conditions, such as depression and chronic pain, including the medications taken for these conditions. Results Twenty‐six patients (5 men, 21 women) aged 45–84 years old with hip (n = 5) and nonhip (n = 21) fractures were recruited. Twenty‐one participants reported depression and/or chronic nonfracture pain, of which seven reported having both depression and chronic pain. Two themes were consistent, based on our analysis: (1) depression and chronic pain overshadowed attention to bone health; and (2) the fracture exacerbated reported experiences of existing depression and chronic pain. Conclusion Experiences with depression and pain take priority over bone health and may worsen as a result of the fracture. Health care providers treating fragility fractures might ask patients about depression and pain and take appropriate steps to address patients' more general emotional and physical state. Patient Contribution A patient representative was involved in the study conception, data interpretation and manuscript writing.
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Affiliation(s)
- Joanna E M Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Lucy Frankel
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Stephen Thielke
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Earl Bogoch
- Department of Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.,Brookfield Chair, Toronto, Ontario, Canada
| | - Victoria Elliot-Gibson
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Gillian Hawker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Morin SN, Djekic-Ivankovic M, Funnell L, Giangregorio L, Rodrigues IB, Ridout R, Feldman S, Kim S, McDonald-Blumer H, Kline G, Ward WE, Santesso N, Leslie WD. Patient engagement in clinical guidelines development: input from > 1000 members of the Canadian Osteoporosis Patient Network. Osteoporos Int 2020; 31:867-874. [PMID: 31838552 PMCID: PMC7170816 DOI: 10.1007/s00198-019-05248-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
UNLABELLED Patient engagement in clinical guidelines development is essential. The results of a self-administered online survey identified themes important to people living with osteoporosis and will inform the development of Osteoporosis Canada clinical guidelines recommendations. INTRODUCTION Patient engagement is essential in the development of high-quality and relevant guidelines for osteoporosis management. Osteoporosis Canada (OC) is updating its national clinical practice guidelines in collaboration with people living with osteoporosis in the process. METHODS Using electronic mail, we contacted 6937 members of the Canadian Osteoporosis Patient Network (COPN) to provide input on the selection of relevant content, outcomes, and research questions via a self-administered online survey. Close-ended questions were analyzed using descriptive statistics, and conventional content analysis was conducted for open-ended questions. RESULTS A total of 1108 individuals completed the survey (97% women, 86% stated they lived with osteoporosis). Most participants considered it critical to have recommendations on physical activity and exercise (74%), fall prevention (69%), nutrition (68%), and initial bone mineral density testing (67%). In addition to preventing fractures, over 75% of respondents stated that consideration of preserving quality of life and ability to perform daily activities, preventing admission to long-term care and fracture-related death, and avoiding serious harms from medications were essential outcomes to consider in evaluating the evidence. In terms of selection of research questions, seven themes emerged from the content analysis including pharmacotherapy, screening and monitoring, diet and supplements, education, exercise, alternative therapies, and pain management. CONCLUSIONS Patients emphasized that autonomy, mobility, and quality of life are highly valued outcomes and must be integral to practice guideline development. As expected, guidance on pharmacotherapy, screening and monitoring, and fracture prevention were priorities identified to be included in osteoporosis management guidelines.
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Affiliation(s)
- S N Morin
- McGill University, Montreal, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
| | - M Djekic-Ivankovic
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - L Funnell
- Osteoporosis Canada, Toronto, Canada
| | - L Giangregorio
- University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - I B Rodrigues
- University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - R Ridout
- University of Toronto, Toronto, Canada
| | - S Feldman
- University of Toronto, Toronto, Canada
| | - S Kim
- University of Toronto, Toronto, Canada
| | | | - G Kline
- University of Calgary, Calgary, Canada
| | - W E Ward
- Brock University, St. Catharines, Canada
| | | | - W D Leslie
- University of Manitoba, Winnipeg, Canada
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5
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Mugnier B, Daumas A, Doddoli S, Belmeliani S, Couderc AL, Mizzi B, Lévêque P, Villani P. Adherence to fracture liaison service programs in patients over 70: the hidden part of the iceberg. Osteoporos Int 2020; 31:765-774. [PMID: 31927612 DOI: 10.1007/s00198-020-05290-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
UNLABELLED Significant dropout rates have been observed throughout Fracture Liaison Service (FLS) programs, especially for elderly patients. In an FLS program set up specifically for patients over 70, the non-initiation of osteoporosis treatment was the only factor associated with poor adherence to the program. Neither age nor frailty factors affected adherence. INTRODUCTION FLS programs are considered the most effective interventions for secondary prevention of osteoporotic fractures. Our objective was to identify risk factors for non-adherence to an FLS program set up specifically for patients over 70. METHODS Our multifaceted, intensive program included five appointments over a 2-year period. One hundred sixty-seven patients (mean age 83.5 years) who presented with a recent fragility fracture were enrolled. Multivariable analysis was conducted to determine whether the demographic, clinical, frailty, and osteoporotic risk factors of the patients influenced their adherence to the program. RESULTS About half of the patients did not attend the follow-up visits. According to the regression analysis, non-initiation of osteoporosis treatment was associated with poor adherence to the program (aHR 3.66). Demographic, clinical, dwelling, frailty factors, osteoporotic risk factors, fracture type, or densitometric scores were not associated with adherence. The first self-reported reason for withdrawal was the difficulty of attending several follow-up visits, and the second was the feeling of not being concerned. CONCLUSION We observed that non-initiation of osteoporosis treatment was the only factor correlated with non-adherence to an FLS program. Thus, neither age nor frailty factors should result in patients not being included in FLS. Beyond the necessity of the osteoporosis treatment, good patient understanding of the relevance of all the interventions included in the program is the key.
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Affiliation(s)
- B Mugnier
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France.
| | - A Daumas
- APHM, Hôpital La Timone, Service de Médecine Interne Gériatrie et Thérapeutique, 264 rue Saint Pierre, 13005, Marseille, France
| | - S Doddoli
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - S Belmeliani
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - A-L Couderc
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - B Mizzi
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - P Lévêque
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - P Villani
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
- APHM, Hôpital La Timone, Service de Médecine Interne Gériatrie et Thérapeutique, 264 rue Saint Pierre, 13005, Marseille, France
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6
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Cehic M, Lerner RG, Achten J, Griffin XL, Prieto-Alhambra D, Costa ML. Prescribing and adherence to bone protection medications following hip fracture in the United Kingdom: results from the World Hip Trauma Evaluation (WHiTE) cohort study. Bone Joint J 2019; 101-B:1402-1407. [PMID: 31674239 DOI: 10.1302/0301-620x.101b11.bjj-2019-0387.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group. PATIENTS AND METHODS The World Hip Trauma Evaluation (WHiTE) is a multicentre, prospective cohort of hip fracture patients in NHS hospitals in England and Wales. Patients aged 60 years and older who received operative treatment for a hip fracture were eligible for inclusion in WHiTE. The prescription of bone protection medications was recorded from participants' discharge summaries, and participant-reported use of bone protection medications was recorded at 120 days following surgery. RESULTS Of 5456 recruited patients with baseline data, 2853 patients (52%) were prescribed bone protection medication at discharge, of which oral bisphosphonates were the most common, 4109 patients (75%) were prescribed vitamin D or calcium, and 606 patients (11%) were not prescribed anything. Of those prescribed a bone protection medication, only 932 patients (33%) reported still taking their medication 120 days later. CONCLUSION These data provide a reference for current prescription and adherence rates. Adherence with oral medication remains poor in patients with hip fracture. Cite this article: Bone Joint J 2019;101-B:1402-1407.
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Affiliation(s)
- Matthew Cehic
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Trauma Research, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Robin G Lerner
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK
| | - Xavier L Griffin
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Trauma Research, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Daniel Prieto-Alhambra
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK
| | - Matthew L Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Trauma Research, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
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7
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Abstract
In view of the high imminent risk of having subsequent fractures after a fracture, early evaluation and treatment decisions to prevent subsequent fractures are advocated. After a hip fracture, the fracture liaison service (FLS) and orthogeriatric care are considered the most appropriate organisational approaches for secondary fracture prevention following a recent fracture. Their introduction and implementation have been shown to increase evaluation and treatment of patients at high risk for subsequent fracture. Of real-world cohort studies, most, but not all studies, indicate a lower incidence of fracture and longer survival after treatment with nitrogen-containing bisphosphonates.
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Affiliation(s)
- Piet Geusens
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre +, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Biomedical Research Centre, Hasselt University, Agoralaan, Gebouw D, 3590 Diepenbeek, Belgium.
| | - Sandrine P G Bours
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre +, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - Caroline E Wyers
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, the Netherlands.
| | - Joop P van den Bergh
- Biomedical Research Centre, Hasselt University, Agoralaan, Gebouw D, 3590 Diepenbeek, Belgium; Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, the Netherlands.
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8
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Sale JEM, Gray M, Mancuso D, Inrig T, Boire G, Beaulieu MC, Funnell L, Bogoch E. Treatment recommendations based on fracture risk status are not consistently provided in osteoporosis guidelines. Rheumatol Int 2018; 38:2193-2208. [PMID: 30367203 DOI: 10.1007/s00296-018-4181-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/19/2018] [Indexed: 11/25/2022]
Abstract
We examined international osteoporosis guidelines to determine the tools used to assess fracture risk, the classification of fracture risk presented, and the recommendations based on fracture risk status. We conducted a document analysis of guidelines from the International Osteoporosis Foundation (IOF) website retrieved as of May 10, 2018, focusing on guidelines written in English only. Two reviewers independently reviewed each document and the following data were extracted: (1) fracture risk tool(s) endorsed; (2) classification system used to describe fracture risk status (e.g., low, moderate, high); and (3) recommendations based on risk status (e.g., pharmacological treatment). Two additional reviewers verified all data extraction. A total of 112 guidelines were listed on the IOF website, of which 94 were located either through the provided link or through a PubMed search. Of 70 guidelines written in English, 63 guidelines discussed the concept of fracture risk of which, 39 endorsed FRAX. Twenty-eight guidelines defined fracture risk categories or thresholds which determined recommendations. In total, 26 provided a risk category or threshold which constituted an indication for pharmacotherapy. Twelve guidelines reported a moderate, medium, or intermediate risk category which was associated with variable recommendations for testing and treatment. Despite the generally accepted international shift to fracture risk as a basis for treatment decisions, the majority of guidelines in English did not provide treatment recommendations based on fracture risk status. In guidelines with recommendations based on fracture risk status, thresholds and recommendations varied making international comparisons of treatment difficult.
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Affiliation(s)
- Joanna E M Sale
- Musculoskeletal Health and 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, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.
| | - Matthew Gray
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Daniel Mancuso
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Taucha Inrig
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Gilles Boire
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Room 3853, Sherbrooke, QC, J1H 5N4, Canada
| | - Marie-Claude Beaulieu
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Larry Funnell
- Osteoporosis Canada, 1200 Eglinton Avenue East, Suite 500, Toronto, ON, M3C 1H9, Canada
| | - Earl Bogoch
- Department of Surgery, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
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9
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Swart KMA, van Vilsteren M, van Hout W, Draak E, van der Zwaard BC, van der Horst HE, Hugtenburg JG, Elders PJM. Factors related to intentional non-initiation of bisphosphonate treatment in patients with a high fracture risk in primary care: a qualitative study. BMC FAMILY PRACTICE 2018; 19:141. [PMID: 30139341 PMCID: PMC6108118 DOI: 10.1186/s12875-018-0828-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/14/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adherence to osteoporosis treatment is crucial for good treatment effects. However, adherence has been shown to be poor and a substantial part of the patients don't even initiate treatment. This study aimed to gain insight into the considerations of both osteoporosis patients and general practitioners (GP) concerning intentional non-initiation of bisphosphonate treatment. METHODS Osteoporosis patients and GPs were recruited from the SALT Osteoporosis Study and a transmural fracture liaison service, both carried out in the Netherlands. Using questionnaires, we identified non-starters and starters of bisphosphonate treatment. Semi-structured interviews were conducted to gain a detailed overview of all considerations until saturation of the data was reached. Starters were asked to reflect on the considerations that were brought forward by the non-starters. Interviews were open coded and the codes were classified into main themes and subthemes using an inductive approach. RESULTS 16 non-starters, 10 starters, and 13 GPs were interviewed. We identified three main themes: insufficient medical advice, attitudes towards medication use including concerns about side effects, and disease awareness. From patients' as well as GPs' perspective, insufficient or ambiguous information from the GP influenced the decision of the non-starters to not start bisphosphonates. In contrast, starters were either properly informed, or they collected information themselves. Patients' aversion towards medication, fear of side effects, and a low risk perception also contributed to not starting the medication, whereas starters were aware of their fracture risk and were confident of the outcome of the treatment. Concerns about osteoporosis treatment and its side effects were also expressed by several GPs. Some GPs appeared to have a limited understanding of the current osteoporosis guidelines and the indications for treatment. CONCLUSIONS Many reasons we found for not starting bisphosphonate treatment were related to the patients or the GPs themselves being insufficiently informed. Attitudes of the GPs were shown to play a role in the decision of patients not to start treatment. Interventions need to be developed that are aimed at GPs, and at education of patients.
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Affiliation(s)
- Karin M. A. Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Stichting Artsen Laboratorium en Trombosedienst, Molenwerf 11, 1541 WR Koog aan de Zaan, Netherlands
| | - Myrthe van Vilsteren
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Stichting Artsen Laboratorium en Trombosedienst, Molenwerf 11, 1541 WR Koog aan de Zaan, Netherlands
| | - Wesley van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Esther Draak
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Babette C. van der Zwaard
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Henriette E. van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Petra J. M. Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
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10
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Rothmann MJ, Jakobsen PR, Jensen CM, Hermann AP, Smith AC, Clemensen J. Experiences of being diagnosed with osteoporosis: a meta-synthesis. Arch Osteoporos 2018; 13:21. [PMID: 29511831 DOI: 10.1007/s11657-018-0436-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/15/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED This systematic review provides synthesised knowledge and guidance to health professionals on the experiences and perspectives of being diagnosed with osteoporosis from the patient's point of view. Using individuals' experiences and meanings can promote tailored and targeted information and guidance on osteoporosis, bone care and treatment at different stages of the osteoporosis trajectory. INTRODUCTION To be diagnosed with osteoporosis with or without fragility fractures affects individuals differently. The aim of this review was firstly to aggregate existing qualitative evidence regarding an individual's experience of being diagnosed with osteoporosis at different stages, and secondly, to use a systematic approach to develop a conceptual understanding of central issues relevant for health professionals in order to provide support and guidance to patients/individuals. METHODS This study used a systematic review methodology and methods for qualitative synthesis as recommended by Cochrane and integrated the findings of qualitative research from eight databases (Medline, PubMed, CINAHL, Embase, SweMed+, PsycINFO, ERIC, Web of Science) to July 2016. Selection and assessment were performed by three authors while four authors were involved in the analysis. Findings were cross-checked with the original article to ensure consistency with the individual's accounts. RESULTS Our findings have revealed that individuals diagnosed with osteoporosis do not perceive osteoporosis as a biomedical trajectory but as a self-perceived continuum of severity and health. To be diagnosed with osteoporosis affects individuals differently depending on, for example, personal experience, pre-conceived notions of or knowledge about the disease, fragility fractures or pain. Hence, individuals will create a meaning of the diagnosis based on self-perceived fracture risk, self-perceived severity of osteoporosis and at the same time, self-perceived health. CONCLUSIONS This meta-synthesis provides knowledge for health professionals on the experiences and perspectives of being diagnosed with osteoporosis from the patient's point of view. The experience, meaning and significance of osteoporosis must be taken into consideration and can be used to promote tailored and targeted information and guidance on osteoporosis, bone care and treatment at different stages of the osteoporosis trajectory.
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Affiliation(s)
- M J Rothmann
- Department of Endocrinology, Odense University Hospital, Kloevervaenget 6, 8.sal, 5000, Odense C, Denmark. .,Department of Rheumatology, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.
| | - P R Jakobsen
- Department of Endocrinology, Odense University Hospital, Kloevervaenget 6, 8.sal, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark
| | - C M Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - A P Hermann
- Department of Endocrinology, Odense University Hospital, Kloevervaenget 6, 8.sal, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A C Smith
- Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.,Centre for Online Health, University of Queensland, Brisbane, QLD, Australia
| | - J Clemensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark
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11
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Abstract
PURPOSE OF REVIEW The purpose of this review is to report the evidence of beneficial effects of Fracture Liaison Service (FLS) including data regarding their impact on subsequent fracture, mortality risk and cost-effectiveness. This review also discusses the limitations of these data and the challenges faced during the implementation of FLS. RECENT FINDINGS Recent studies showed the beneficial impact of implementation of FLS on the prevention of subsequent fracture risk, reduced mortality and cost-effectiveness. However, heterogeneity of FLS models and small number of studies limited the conclusion about the impact of FLS on secondary fracture prevention. SUMMARY Patients with osteoporosis-related fractures are at higher risk of subsequent refractures. These subsequent fractures are associated with increased morbidity and premature mortality. However, there is a gap between evidence-based recommendations for postfracture care and actual clinical practice. FLS care is recommended for the management of the prevention of secondary fracture. FLS implementation reduces the risk of subsequent fracture, but the level of evidence is low as the interpretation of data is limited by the number of studies and their heterogeneity. FLS care significantly reduces the postfracture mortality, especially in patients with hip fractures. FLS implementation is cost-effective compared with usual care. Additional studies (with large sample and long-term follow-up) are needed to assess the impact of FLS care on subsequent fracture risk.
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12
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Deloumeau A, Moltó A, Roux C, Briot K. Determinants of short term fracture risk in patients with a recent history of low-trauma non-vertebral fracture. Bone 2017; 105:287-291. [PMID: 28842362 DOI: 10.1016/j.bone.2017.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/30/2017] [Accepted: 08/19/2017] [Indexed: 12/16/2022]
Abstract
Low-trauma fractures tend to cluster in time, and subsequent fractures have a role in increased morbidity and mortality in osteoporotic patients. The aim of this study was to identify the risk factors of short-term subsequent non-vertebral fracture (NVF). Patients were included from the Fracture Liaison Service (FLS) which provides assessment for osteoporosis to all in-hospital patients admitted for a low-trauma NVF in the Orthopaedics department. Location and date of occurrence of previous fractures, risk factors for osteoporosis and falls were collected. Bone mineral density was measured at the lumbar spine and total hip; presence of vertebral fractures was evaluated using vertebral fracture assessment (VFA). Nine hundred and fifty patients were included (84% women; 75±12years), with a mean T-score at the femoral neck of -2.3±1.0. Four hundred and sixty eight (49%) patients were in the FLS because of a hip fracture. Using multivariable analysis, the risk of being in the FLS with a previous fracture ≤3years before was associated with: history of fall in the year before the admission (OR=2.75, CI 95% 1.55-4.93), history of severe low-trauma NVF (OR=2.54; CI 95% 1.45-4.52), and BMI lower than 20kg/m2 (OR=2.45, CI 95% 1.25-4.87); age older than 78years-old was protective to the risk of re-fracture (OR=0.44, CI 95% 0.24-0.80). Some risk factors (age, history of fall and of previous severe non-vertebral fracture) can help in the selection of patients at high risk of refracture, who should receive the highest priority for a treatment.
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Affiliation(s)
- Aude Deloumeau
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France.
| | - Anna Moltó
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France
| | - Christian Roux
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France
| | - Karine Briot
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France.
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13
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Schousboe JT. Mortality After Osteoporotic Fractures: What Proportion Is Caused by Fracture and Is Preventable? J Bone Miner Res 2017; 32:1783-1788. [PMID: 28691759 DOI: 10.1002/jbmr.3216] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/06/2017] [Indexed: 01/23/2023]
Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic & HealthPartners Institute, HealthPartners, Minneapolis, MN, USA.,Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
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14
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Abstract
The clinical significance of osteoporosis is in the occurrence of fractures and re-fractures. The main risk factor of sustaining a fracture is a previous one, but a recent fracture is a better fracture risk factor than fracture history. The role of the recency of fracture has been shown for both vertebral and non-vertebral fracture risk. This imminent risk is explained by both bone-related factors (underlying osteoporosis) and fall-related factors (including those related to postfracture care). Such a short-term increased risk has been shown also in patients initiating corticosteroids and in frail osteoporotic subjects with central nervous system (CNS) diseases or drugs targeting CNS, and thus a high risk of falls. Patients with an imminent (i.e. 2 years) risk of fracture or refracture should be identified in priority in order to receive an immediate treatment and a program of fall prevention.
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Affiliation(s)
- C Roux
- Paris Descartes University, Paris, France.
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, UMR U1153, Paris, France.
- Department of Rheumatology, Cochin Hospital, Assistance-Publique-Hôpitaux de Paris, Paris, France.
| | - K Briot
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, UMR U1153, Paris, France
- Department of Rheumatology, Cochin Hospital, Assistance-Publique-Hôpitaux de Paris, Paris, France
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15
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Bogoch ER, Elliot-Gibson V, Beaton D, Sale J, Josse RG. Fracture Prevention in the Orthopaedic Environment: Outcomes of a Coordinator-Based Fracture Liaison Service. J Bone Joint Surg Am 2017; 99:820-831. [PMID: 28509822 DOI: 10.2106/jbjs.16.01042] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fracture liaison services focus on secondary fracture prevention by identifying patients at risk for future fracture and initiating appropriate evaluation, risk assessment, education, and therapeutic intervention. This study describes key clinical outcomes including bone mineral densitometry, physician assessment, and pharmacotherapy initiation in pharmacotherapy-naïve patients undergoing treatment for fragility fracture in a Canadian fracture liaison service. METHODS We determined rates of post-fracture investigation and treatment for inpatients and outpatients with a fragility fracture seen in a coordinator-based fracture liaison service at an urban university trauma hospital. The program identified distal radial, proximal femoral, proximal humeral, and vertebral fragility fractures in female patients ≥40 years of age and male patients ≥50 years of age and provided education, bone mineral densitometry, inpatient consultation or outpatient specialist or primary care physician referral for bone health management, and documented patient follow-up. RESULTS The 2,191 patients with a fragility fracture were not taking anti-osteoporosis pharmacotherapy at the time of identification (862 inpatients and 1,329 outpatients). Eighty-four percent of inpatients and 85% of outpatients completed a bone mineral densitometry as recommended. Fifty-two percent of patients with proximal femoral fracture, 29% of patients with vertebral fracture, 26% of patients with proximal humeral fracture, and 20% of patients with distal radial fracture had osteoporosis confirmed on the basis of a bone mineral densitometry T-score of ≤-2.5 at the femoral neck or L1 to L4. Eighty-five percent of inpatients and 79% of outpatients referred for bone health management were assessed by a specialist or primary care physician. Of the patients who attended their appointments, 73% of inpatients and 52% of outpatients received a prescription for anti-osteoporosis medication. CONCLUSIONS A high rate of education, evaluation, and pharmacological treatment, if indicated, can be achieved through a coordinator-facilitated fracture liaison service program. CLINICAL RELEVANCE Fracture prevention programs are currently engaged in establishing and modifying fracture liaison services in a quest for practical and effective models. The program described in this article exemplifies a coordinator-based model that produced good outcomes.
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Affiliation(s)
- Earl R Bogoch
- 1Division of Orthopaedic Surgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada 2Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada 4Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
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16
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Sale JEM, Ashe MC, Beaton D, Bogoch E, Frankel L. Men's health-seeking behaviours regarding bone health after a fragility fracture: a secondary analysis of qualitative data. Osteoporos Int 2016; 27:3113-9. [PMID: 27234669 DOI: 10.1007/s00198-016-3641-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED In our qualitative study, men with fragility fractures described their spouses as playing an integral role in their health behaviours. Men also described taking risks, preferring not to dwell on the meaning of the fracture and/or their bone health. Communication strategies specific to men about bone health should be developed. INTRODUCTION We examined men's experiences and behaviours regarding bone health after a fragility fracture. METHODS We conducted a secondary analysis of five qualitative studies. In each primary study, male and female participants were interviewed for 1-2 h and asked to describe recommendations they had received for bone health and what they were doing about those recommendations. Maintaining the phenomenological approach of the primary studies, the transcripts of all male participants were re-analyzed to highlight experiences and behaviours particular to men. RESULTS Twenty-two men (50-88 years old) were identified. Sixteen lived with a wife, male partner, or family member and the remaining participants lived alone. Participants had sustained hip fractures (n = 7), wrist fractures (n = 5), vertebral fractures (n = 2) and fractures at other locations (n = 8). Fourteen were taking antiresorptive medication at the time of the interview. In general, men with a wife/female partner described these women as playing an integral role in their health behaviours, such as removing tripping hazards and organizing their medication regimen. While participants described giving up activities due to their bone health, they also described taking risks such as drinking too much alcohol and climbing ladders or deliberately refusing to adhere to bone health recommendations. Finally, men did not dwell on the meaning of the fracture and/or their bone health. CONCLUSIONS Behaviours consistent with those shown in other studies on men were described by our sample. We recommend that future research address these findings in more detail so that communication strategies specific to men about bone health be developed.
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Affiliation(s)
- J E M Sale
- Musculoskeletal Health and 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, Toronto, ON, Canada.
| | - M C Ashe
- Centre for Hip Health and Mobility, Robert H.N. Ho Research Centre, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - D Beaton
- Musculoskeletal Health and 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, Toronto, ON, Canada
| | - E Bogoch
- Mobility Program, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - L Frankel
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
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