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Maas L, Boonen A, Li N, Wyers CE, Van den Bergh JP, Hiligsmann M. Cost-effectiveness of a multicomponent-adherence intervention in fracture liaison services. Expert Rev Pharmacoecon Outcomes Res 2024; 24:987-996. [PMID: 38860294 PMCID: PMC11418902 DOI: 10.1080/14737167.2024.2366439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND This study aims to assess the lifetime cost-effectiveness of a multi-component adherence intervention (MCAI), including a patient decision aid and motivational interviewing, compared to usual care in patients with a recent fracture attending fracture liaison services (FLS) and eligible for anti-osteoporosis medication (AOM). RESEARCH DESIGN AND METHODS Data on AOM initiation and one-year persistence were collected from a quasi-experimental study conducted between 2019 and 2023 in two Dutch FLS centers. An individual level, state-transition Markov model was used to simulate lifetime costs and quality-adjusted life years (QALYs) with a societal perspective of MCAI vs usual care. One-way and probabilistic sensitivity analyses were conducted including variation in additional FLS and MCAI costs (no MCAI cost in baseline). RESULTS MCAI was associated with gain in QALYs (0.0012) and reduction in costs (-€16) and is therefore dominant. At the Dutch willingness-to-pay threshold of €50,000/QALY, MCAI remained cost-effective when increasing costs of the FLS visit or the yearly maintenance cost for MCAI up to +€60. Probabilistic sensitivity analysis demonstrated MCAI to be dominant in 54% of the simulations and cost-effective in 87% with a threshold of €50,000/QALY. CONCLUSIONS A MCAI implemented in FLS centers may lead to cost-effective allocation of resources in FLS care, depending on extra costs.
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Affiliation(s)
- Lieke Maas
- Department of Health Services research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Health Services research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nannan Li
- Department of Health Services research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Caroline E. Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joop P. Van den Bergh
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Herbst AN, McCullough MB, Wiener RS, Barker AM, Maguire EM, Fix GM. Proactively tailoring implementation: the case of shared decision-making for lung cancer screening across the VA New England Healthcare Network. BMC Health Serv Res 2023; 23:1282. [PMID: 37993840 PMCID: PMC10664378 DOI: 10.1186/s12913-023-10245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Shared Decision-Making to discuss how the benefits and harms of lung cancer screening align with patient values is required by the US Centers for Medicare and Medicaid and recommended by multiple organizations. Barriers at organizational, clinician, clinical encounter, and patient levels prevent SDM from meeting quality standards in routine practice. We developed an implementation plan, using the socio-ecological model, for Shared Decision-Making for lung cancer screening for the Department of Veterans Affairs (VA) New England Healthcare System. Because understanding the local context is critical to implementation success, we sought to proactively tailor our original implementation plan, to address barriers to achieving guideline-concordant lung cancer screening. METHODS We conducted a formative evaluation using an ethnographic approach to proactively identify barriers to Shared Decision-Making and tailor our implementation plan. Data consisted of qualitative interviews with leadership and clinicians from seven VA New England medical centers, regional meeting notes, and Shared Decision-Making scripts and documents used by providers. Tailoring was guided by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). RESULTS We tailored the original implementation plan to address barriers we identified at the organizational, clinician, clinical encounter, and patient levels. Overall, we removed two implementation strategies, added five strategies, and modified the content of two strategies. For example, at the clinician level, we learned that past personal and clinical experiences predisposed clinicians to focus on the benefits of lung cancer screening. To address this barrier, we modified the content of our original implementation strategy Make Training Dynamic to prompt providers to self-reflect about their screening beliefs and values, encouraging them to discuss both the benefits and potential harms of lung cancer screening. CONCLUSIONS Formative evaluations can be used to proactively tailor implementation strategies to fit local contexts. We tailored our implementation plan to address unique barriers we identified, with the goal of improving implementation success. The FRAME-IS aided our team in thoughtfully addressing and modifying our original implementation plan. Others seeking to maximize the effectiveness of complex interventions may consider using a similar approach.
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Affiliation(s)
- Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Megan B McCullough
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, US, USA
- The Pulmonary Center, Boston University Chobanian &, Avedisian School of Medicine, Boston, MA, USA
| | - Anna M Barker
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Elizabeth M Maguire
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Nogués X, Carbonell MC, Canals L, Lizán L, Palacios S. Current situation of shared decision making in osteoporosis: A comprehensive literature review of patient decision aids and decision drivers. Health Sci Rep 2022; 5:e849. [PMID: 36425899 PMCID: PMC9679236 DOI: 10.1002/hsr2.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/20/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Osteoporosis is a systemic skeletal disease characterized by low bone mass and microstructural deterioration of bone tissues, resulting in bone fragility and increased fracture risk. It is the most common bone-related disease in the population. However, the proportion of patients who start treatment but discontinue it during the first year is very high (around 50%). Endeavors are made to promote patient participation in treatment by implementing patient decision aids (PDA), whose function is to help the patient make disease-related decisions. We aim to summarize the characteristics of the currently available PDA for osteoporosis, as well as deciding factors. Methods Comprehensive review of the literature. Results Currently, eleven PDAs can be found for osteoporosis. These PDA have different characteristics or options such as information about treatments tailored to patient needs, graphic information of the results (to facilitate understanding), personal histories (learning), tests to check the knowledge acquired, provision of evidence, clinical practice guidelines or a final summary to share with their doctor. Only five of these PDAs can be considered complete since they provide relevant disease information and therapeutic options to the patient, promote patient's reflection and foment patient-physician discussion. Conclusions This study provides an update on the current state of decision making on osteoporosis and available PDA, which can help engage the patient through shared decision-making by considering, among other things, patient preferences. Physicians should consider PDA, as it may promote adherence and effectiveness of treatment.
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Affiliation(s)
- Xavier Nogués
- Internal Medicine Department, Instituto de investigación hospital del Mar (IMIM)—Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)Universitat Autonòma de BarcelonaBarcelonaSpain
| | - María Cristina Carbonell
- Department of Medicine, Atenció Primària Barcelona—Institut Català de la Salut (ICS), Grupo GREMPALUniversidad de BarcelonaBarcelonaSpain
| | - Laura Canals
- Department of MedicineAmgen EuropeRisch‐RotkreuzSwitzerland
| | - Luis Lizán
- Department of Outcomes ResearchOutcomes'10Castellón de la PlanaSpain
- Department of MedicineUniversitat Jaume ICastellón de la PlanaSpain
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Fu SH, Wang CY, Li CY. Authors' reply: Increased fracture risk after discontinuation of anti-osteoporosis medications among hip fracture patients. J Intern Med 2022; 291:386-387. [PMID: 34779060 DOI: 10.1111/joim.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S-H Fu
- Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - C-Y Wang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,College of Medicine, Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan
| | - C-Y Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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5
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Beaudart C, Hiligsmann M, Li N, Lewiecki EM, Silverman S. Effective communication regarding risk of fracture for individuals at risk of fragility fracture: a scoping review. Osteoporos Int 2022; 33:13-26. [PMID: 34559256 PMCID: PMC8758611 DOI: 10.1007/s00198-021-06151-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 09/03/2021] [Indexed: 12/28/2022]
Abstract
Two scoping reviews were conducted to review recommendations and guidelines for communication regarding general health risk, and to investigate communication strategies regarding risk of fracture. Healthcare professionals are invited to apply these recommendations to optimize a patient-centered approach to reducing risk of fracture. INTRODUCTION To conduct a scoping review of the medical literature regarding recommendations and tools for effective communication between healthcare professionals and patients regarding general health risk and risk of fracture. METHODS The scoping review was divided into two parts to search for (1) studies presenting recommendations and guidelines for communication regarding general health risk; (2) studies investigating communication regarding risk of fracture for individuals at risk for fractures. Medline was searched in April 2020 to identify relevant studies. RESULTS The scoping review included 43 studies on communication with regard to general health risk and 25 studies about communication regarding risk of fracture. Recommendations for effective communication with regard to risk are presented. Communication of numeric data on risk should be adapted to the literacy and numeracy levels of the individual patient. Patient understanding of numerical data can be enhanced with appropriate use of visual aids (e.g., pie charts, icon arrays, bar charts, pictograms). The FRAX® tool is the most recommended and most used tool for assessing risk of fracture. Communication sent as individualized letters to patients following DXA scans has been studied, although patient understanding of their risk of fracture is often reported as low using this technique. Use of visual aids may improve patient understanding. CONCLUSION Healthcare professionals are encouraged to apply recommendations presented in this scoping review in their clinical practice. Patient understanding of risk of fracture should be confirmed by making sure that patients feel free to ask questions and express their concerns. This will contribute to an optimal patient-centered approach. Developing online tools to convert the probability of fracture into patient-friendly visual presentations could facilitate communication between healthcare professionals and patients about risk of fracture.
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Affiliation(s)
- Charlotte Beaudart
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nannan Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Stuart Silverman
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
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Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan. Healthcare (Basel) 2021; 9:healthcare9111402. [PMID: 34828449 PMCID: PMC8625753 DOI: 10.3390/healthcare9111402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022] Open
Abstract
(1) Background: The prevalence of opioid use in Taiwan increased by 41% between 2002 and 2014. However, little is known regarding the risk of mortality among long-term opioid analgesics users who do not have cancer. This study investigated this mortality risk with an emphasis on the calendar year and patients’ age and sex. (2) Methods: This retrospective cohort study included 12,990 adult individuals without cancer who were long-term users of opioid analgesics and were randomly selected from the data set of Taiwan’s National Health Insurance program from 2000 to 2012. They were then followed up through 2013. Information on the underlying causes of death was retrieved from the Taiwan Death Registry. Age, sex, and calendar year-standardized mortality ratios (SMRs) of all-cause and cause-specific mortality were calculated with reference to those of the general population. (3) Results: With up to 14 years of follow-up, 558 individuals had all-cause mortality in 48,020 person-years (cumulative mortality: 4.3%, mortality rate: 11.62 per 1000 person-years). Compared with the general population, the all-cause SMR of 4.30 (95% confidence interval (95% CI): 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural (5.04, 95% CI: 3.88–6.45) causes. (4) Conclusions: Long-term opioid analgesics use among individuals without cancer in Taiwan was associated with a significantly increased risk of mortality. The notably increased mortality in younger adults warrants attention. Strategies to reduce long-term opioid analgesics use, especially their overuse or misuse, are in an urgent need.
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Canals-Ruiz L, Comellas M, Lizán L. Preferences, satisfaction and decision-making processes in osteoporosis treatment: a systematic review of the literature. J Comp Eff Res 2021; 10:629-645. [PMID: 33880940 DOI: 10.2217/cer-2020-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To synthesize information available in the literature on patients' preferences and satisfaction with osteoporosis treatment and their unmet needs on the treatment decision-making process. Materials & methods: Systematic literature review consulting international database and grey literature of articles published between January 1, 2009 and January 1, 2019. Results: Nineteen publications were reviewed, 79% of them focused on evaluating the importance that patients attached to the mode and frequency of administration, adverse events and treatment efficacy. 21% of them provided information about treatment satisfaction and 26% regarding unmet needs on treatment-decision making process. Conclusion: Aligning treatment with patients' preferences, promoting physician-patient communication and identifying patients' concerns with treatment may contribute to improve treatment satisfaction and adherence and ultimately achieve the treatment goal.
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Affiliation(s)
| | | | - Luís Lizán
- Outcomes10, Castellon, Spain.,Department of Medicine, University Jaume I, Castellon, Spain
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8
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Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, Harris ST, Hurley DL, Kelly J, Lewiecki EM, Pessah-Pollack R, McClung M, Wimalawansa SJ, Watts NB. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS-2020 UPDATE. Endocr Pract 2020; 26:1-46. [PMID: 32427503 DOI: 10.4158/gl-2020-0524suppl] [Citation(s) in RCA: 468] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) evidence level (EL) 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very-high-risk features, a new dual-action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of post-menopausal osteoporosis. Abbreviations: 25(OH)D = 25-hydroxyvitamin D; AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; AFF = atypical femoral fracture; ASBMR = American Society for Bone and Mineral Research; BEL = best evidence level; BMD = bone mineral density; BTM = bone turnover marker; CI = confidence interval; CPG = clinical practice guideline; CTX = C-terminal telopeptide type-I collagen; DXA = dual-energy X-ray absorptiometry; EL = evidence level; FDA = U.S. Food and Drug Administration; FRAX® = Fracture Risk Assessment Tool; GI = gastrointestinal; HORIZON = Health Outcomes and Reduced Incidence with Zoledronic acid ONce yearly Pivotal Fracture Trial (zoledronic acid and zoledronate are equivalent terms); ISCD = International Society for Clinical Densitometry; IU = international units; IV = intravenous; LSC = least significant change; NOF = National Osteoporosis Foundation; ONJ = osteonecrosis of the jaw; PINP = serum amino-terminal propeptide of type-I collagen; PTH = parathyroid hormone; R = recommendation; ROI = region of interest; RR = relative risk; SD = standard deviation; TBS = trabecular bone score; VFA = vertebral fracture assessment; WHO = World Health Organization.
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9
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Fuzzell LN, Richards MJ, Fraenkel L, Stark SL, Politi MC. What information can the lay public find about osteoporosis treatment? A descriptive study coding the content and quality of bisphosphonate information on the internet. Osteoporos Int 2019; 30:2299-2310. [PMID: 31297567 PMCID: PMC6885753 DOI: 10.1007/s00198-019-05008-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/02/2019] [Indexed: 01/28/2023]
Abstract
UNLABELLED Despite its effectiveness, bisphosphonate use for osteoporosis is low. We assessed bisphosphonate information on the internet and found the most commonly listed benefits/risks were bone density loss, gastrointestinal issues, and jaw necrosis, that risk quantification was rare, and information quality varied. Findings underscore the importance of clinical communication about bisphosphonates. INTRODUCTION The US Preventative Services Task Force recommends osteoporosis screening and treatment with bisphosphonates in high-risk populations. However, bisphosphonate use among individuals with osteoporosis remains low. The content and quality of information from outside sources may influence individuals' bisphosphonate decisions. Therefore, we sought to assess the content and quality of osteoporosis treatment information available to the public by conducting an internet search and coding available bisphosphonate information. METHODS Eleven search terms about osteoporosis and bisphosphonates were entered into four search engines. Two raters assessed websites for information about bisphosphonates, whether and how benefits and side effects were described and quantified, contraindications, and dosing instructions. Coders also assessed website interface and slant/balance of information. RESULTS One thousand four hundred seventy-three websites were identified. Two hundred twenty-seven websites met inclusion criteria and were coded. The most common bisphosphonate benefit described was prevention of bone density loss (77.1% of websites). The most common side effects described were gastrointestinal problems (66.1%) and jaw osteonecrosis (58.6%). Most websites did not quantify bisphosphonate benefits (78.0%) or side effects (82.4%). Complementary/integrative health websites (p < .001) and pharmaceutical litigation websites (p < .001) were more often slanted against taking bisphosphonates, compared to all websites coded. General medical knowledge websites were more balanced than other websites (p = .023). CONCLUSIONS The quality of bisphosphonate information on the internet varies substantially. Providers counseling patients about osteoporosis treatment should inquire about patients' baseline bisphosphonate knowledge. Providers can complement accurate information and address potential bisphosphonate misconceptions.
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Affiliation(s)
- L N Fuzzell
- School of Medicine, Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - M J Richards
- School of Medicine, Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - L Fraenkel
- School of Medicine, Department of Rheumatology, Yale University, New Haven, CT, USA
| | - S L Stark
- School of Medicine, Department of Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - M C Politi
- School of Medicine, Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
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Hiligsmann M, Cornelissen D, Vrijens B, Abrahamsen B, Al-Daghri N, Biver E, Brandi ML, Bruyère O, Burlet N, Cooper C, Cortet B, Dennison E, Diez-Perez A, Gasparik A, Grosso A, Hadji P, Halbout P, Kanis JA, Kaufman JM, Laslop A, Maggi S, Rizzoli R, Thomas T, Tuzun S, Vlaskovska M, Reginster JY. Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF). Osteoporos Int 2019; 30:2155-2165. [PMID: 31388696 PMCID: PMC6811382 DOI: 10.1007/s00198-019-05104-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
Abstract
UNLABELLED Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions. INTRODUCTION Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication. METHODS A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research. A systematic literature review and a face-to-face experts meeting were undertaken. RESULTS Medication non-adherence is associated with increased risk of fractures, leading to a substantial decrease in the clinical and economic benefits of drug therapy. Reasons for non-adherence are numerous and multidimensional for each patient, depending on the interplay of multiple factors, suggesting the need for multifactorial and individualized solutions. Few interventions have been shown to improve adherence or persistence to osteoporosis treatment. Promising actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen. Recommendations for practice and further research were also provided. To adequately manage adherence, it is important to (1) understand the problem (initiation, implementation and/or persistence), (2) to measure adherence and (3) to identify the reason of non-adherence and fix it. CONCLUSION These recommendations are intended for clinicians to manage adherence of their patients and to researchers and policy makers to design, facilitate and appropriately use adherence interventions.
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Affiliation(s)
- M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - D Cornelissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - B Vrijens
- Research and Development, AARDEX Group and Department of Public Health, University of Liège, Liege, Belgium
| | - B Abrahamsen
- Open Patient Data Explorative Network, Institute of Clinical Resesarch, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- NDORMS, University of Oxford, Oxford, UK
| | - N Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - E Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M L Brandi
- FirmoLab, Fondazione FIRMO e Università di Firenze, Florence, Italy
| | - O Bruyère
- Division of Public Health, Epidemiology and Health Economics, Liège, Belgium and WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liege, Belgium
| | - N Burlet
- Global Head of Patient Insights Innovation, Patient Solution Unit, Sanofi, Lyon, France
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - B Cortet
- Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - A Diez-Perez
- Musculoskeletal Research Unit, IMIM-Parc Salut Mar, CIBERFES, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Gasparik
- Department of Public Health, University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - A Grosso
- Patient partner, Geneva, Switzerland
| | - P Hadji
- Frankfurt Centre of Bone Health, Frankfurt, Germany & Philips-University of Marburg, Marburg, Germany
| | - P Halbout
- International Osteoporosis Foundation, Nyon, Switzerland
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Health Institute, Catholic University of Australia, Melbourne, Australia
| | - J M Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - A Laslop
- Scientific Office, Austrian Federal Office for Safety in Health Care, Vienna, Austria
| | - S Maggi
- CNR Aging Branch-NI, Padua, Italy
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - T Thomas
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne and INSERM U1059, Université de Lyon-Université Jean Monnet, Saint-Etienne, France
| | - S Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, İstanbul University Cerrahpaşa, Istanbul, Turkey
| | - M Vlaskovska
- Medical Faculty, Department of Pharmacology, Medical University Sofia, Sofia, Bulgaria
| | - J Y Reginster
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
- Division of Public Health, Epidemiology and Health Economics, Liège, Belgium and WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liege, Belgium
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Camacho PM, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL, Kleerekoper M, Lewiecki EM, Miller PD, Narula HS, Pessah-Pollack R, Tangpricha V, Wimalawansa SJ, Watts NB. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS - 2016. Endocr Pract 2019; 22:1-42. [PMID: 27662240 DOI: 10.4158/ep161435.gl] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABBREVIATIONS AACE = American Association of Clinical Endocrinologists AFF = atypical femur fracture ASBMR = American Society for Bone and Mineral Research BEL = best evidence level BMD = bone mineral density BTM = bone turnover marker CBC = complete blood count CI = confidence interval DXA = dual-energy X-ray absorptiometry EL = evidence level FDA = U.S. Food and Drug Administration FLEX = Fracture Intervention Trial (FIT) Long-term Extension FRAX® = Fracture Risk Assessment Tool GFR = glomerular filtration rate GI = gastrointestinal HORIZON = Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly IOF = International Osteoporosis Foundation ISCD = International Society for Clinical Densitometry IU = international units IV = intravenous LSC = least significant change NBHA = National Bone Health Alliance NOF = National Osteoporosis Foundation 25(OH)D = 25-hydroxy vitamin D ONJ = osteonecrosis of the jaw PINP = serum carboxy-terminal propeptide of type I collagen PTH = parathyroid hormone R = recommendation RANK = receptor activator of nuclear factor kappa-B RANKL = receptor activator of nuclear factor kappa-B ligand RCT = randomized controlled trial RR = relative risk S-CTX = serum C-terminal telopeptide SQ = subcutaneous VFA = vertebral fracture assessment WHO = World Health Organization.
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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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Taylor BJ, Stevenson M, McDowell M. Communicating risk in dementia care: Survey of health and social care professionals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e291-e303. [PMID: 29226458 DOI: 10.1111/hsc.12519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk-taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision-making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June-September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low-moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice-based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants' responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10-fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed.
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Affiliation(s)
- Brian J Taylor
- Institute for Social Sciences, Ulster University, Northern Ireland, UK
| | - Mabel Stevenson
- School of Sociology & Applied Social Studies, Ulster University, Northern Ireland, UK
| | - Michelle McDowell
- Harding Centre for Risk Literacy, Max Planck Institute, Berlin, Germany
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14
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Phueanpinit P, Pongwecharak J, Sumanont S, Krska J, Jarernsiripornkul N. Physicians' communication of risks from non-steroidal anti-inflammatory drugs and attitude towards providing adverse drug reaction information to patients. J Eval Clin Pract 2017; 23:1387-1394. [PMID: 28809071 DOI: 10.1111/jep.12806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 12/25/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for orthopaedic conditions, therefore this study aimed to explore orthopaedic physicians' perceptions of their role in NSAID-risk communication, their attitudes towards the necessity of informing patients about adverse drug reactions (ADR), and factors associated with these. METHODS Self-administered questionnaires were mailed to all 206 orthopaedic physicians working at hospitals in Northeastern Thailand. Attitudes were assessed using 17 statements and total scores classed as poor, moderate and good attitude. RESULTS Sixty-six questionnaires were returned (32.04%). The responses showed that 75% of physicians claimed to communicate NSAID ADR information, more frequently about gastrointestinal (GI) complications, than about renal and cardiovascular (CVS) complications. ADR management (36%) and monitoring (30%) were not frequently communicated. The time spent with patients was associated with provision of ADR and monitoring advice. Renal function was the risk factor of greatest concern for prescribing any NSAID, followed by history of GI complications, and allergy for non-selective NSAIDs, and history of CVS diseases and age for selective COX-2 NSAIDs. Most physicians (41) had moderate attitude towards providing information and 24 good attitude. Fewer physicians working in tertiary hospitals than general and community hospital physicians considered that time limitations prevented counseling and that patient information leaflets offered easily accessible information. Additionally, more physicians who did not inform patients about ADRs agreed that ADR communication can lead to anxiety and discontinuing treatment. CONCLUSION The study indicates that, although orthopaedic physicians had positive attitudes towards providing ADR information to patients, improvement is needed in communicating NSAID risk information.
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Affiliation(s)
- Pacharaporn Phueanpinit
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Kent, UK
| | - Narumol Jarernsiripornkul
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
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Lems WF, Raterman HG. Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs. Ther Adv Musculoskelet Dis 2017; 9:299-316. [PMID: 29201155 DOI: 10.1177/1759720x17732562] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/29/2017] [Indexed: 12/31/2022] Open
Abstract
Osteoporosis is a silent disease with increasing prevalence due to the global ageing population. Decreased bone strength and bone quality is the hallmark of osteoporosis which leads to an increased risk of fragility fractures in elderly. It has been estimated that approximately ~50% of women will suffer during their lifetime from an osteoporotic fracture. This must be considered as a major health concern, as it has previously been established that fragility fracture has been associated with decreased quality of life due to increased disability, more frequent hospital admission and most importantly, osteoporotic fractures have been related to an augmented mortality risk. Anti-osteoporotic drugs are available for improving bone quality. Although there is access to these therapeutic options, there remain multiple unmet needs in the field of osteoporosis and fracture care, for example, the primary prevention of osteoporosis in young individuals (to reach a high peak bone mass), the optimization of the use of imaging techniques [dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA) and new techniques measuring bone quality], the use of nonmedical treatment options and surgical techniques of fracture healing. In this review, we will discuss topics that play a role in the occurrence and prevention of fractures, and we give an overview of and insight into the critical issues and challenges around osteoporosis and fracture prevention.
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Affiliation(s)
- Willem F Lems
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre and Reade, P.O. Box 7057 1007 MB Amsterdam, The Netherlands
| | - Hennie G Raterman
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre and Reade, North West Clinics, Alkmaar, The Netherlands
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16
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Lovato C, Lewiecki EM. Emerging anabolic agents in the treatment of osteoporosis. Expert Opin Emerg Drugs 2017; 22:247-257. [DOI: 10.1080/14728214.2017.1362389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Christina Lovato
- Division of Endocrinology, Diabetes and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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17
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Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, Blauth M, Czerwinski E, da Silva J, Herrera A, Hoffmeyer P, Kvien T, Maalouf G, Marsh D, Puget J, Puhl W, Poor G, Rasch L, Roux C, Schüler S, Seriolo B, Tarantino U, van Geel T, Woolf A, Wyers C, Geusens P. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis 2016; 76:802-810. [PMID: 28007756 DOI: 10.1136/annrheumdis-2016-210289] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/13/2016] [Accepted: 12/02/2016] [Indexed: 01/11/2023]
Abstract
The European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of optimal acute care for the patients aged 50 years and over with a recent fragility fracture and the prevention of subsequent fractures in high-risk patients, which can be facilitated by close collaboration between orthopaedic surgeons and rheumatologists or other metabolic bone experts. Therefore, the aim was to establish for the first time collaborative recommendations for these patients. According to the EULAR standard operating procedures for the elaboration and implementation of evidence-based recommendations, 7 rheumatologists, a geriatrician and 10 orthopaedic surgeons met twice under the leadership of 2 convenors, a senior advisor, a clinical epidemiologist and 3 research fellows. After defining the content and procedures of the task force, 10 research questions were formulated, a comprehensive and systematic literature search was performed and the results were presented to the entire committee. 10 recommendations were formulated based on evidence from the literature and after discussion and consensus building in the group. The recommendations included appropriate medical and surgical perioperative care, which requires, especially in the elderly, a multidisciplinary approach including orthogeriatric care. A coordinator should setup a process for the systematic investigations for future fracture risk in all elderly patients with a recent fracture. High-risk patients should have appropriate non-pharmacological and pharmacological treatment to decrease the risk of subsequent fracture.
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Affiliation(s)
- W F Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - K E Dreinhöfer
- Department of Orthopedics and Traumatology, Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin Berlin Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - H Bischoff-Ferrari
- Departemnt of Geriatrics and Aging Research, University Hospital and University of Zurich, Zurich, Switzerland
| | - M Blauth
- Department for Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - E Czerwinski
- Department of Bone and Joint Diseases, Jagiellonian University, Faculty of Health and Sciences, Krakow Medical Centre, Krakow, Poland
| | - Jap da Silva
- Department of Rheumatology, Faculdade de Medicina e Centro Hospitalar, Universidade de Coimbra, Coimbra, Portugal
| | - A Herrera
- Department of Surgery, University of Zaragoza, Zaragosa, Spain
| | - P Hoffmeyer
- Department of Surgery, Division of Orthopaedics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - T Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - G Maalouf
- Faculty of Medicine, St. Joseph University, Bellevue University Medical Center, Beirut, Lebanon
| | - D Marsh
- University College London, London, UK
| | - J Puget
- Department of Orthopaedic Surgery, Hopital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - W Puhl
- Past President EFORT, University Ulm, Germany
| | - G Poor
- Department of Internal Medicine III, National Institute of Rheumatology and Physiotherapy, Rheumatology Chair, Semmelweis University, Budapest, Hungary
| | - L Rasch
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - C Roux
- Department of Rheumatology, INSERM 1153, Cochin Hospital, Paris Descartes University, Paris, France
| | - S Schüler
- Department of Orthopedics and Traumatology, Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin Berlin Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - B Seriolo
- Research Laboratory and Academic, Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - U Tarantino
- Department of Orthopedics and Traumatology, Tor Vergata University of Rome, Rome, Italy
| | - T van Geel
- Department of Family Medicine, Maastricht University, CAPHRI-School for Public Health and Primary Care, Maastricht, The Netherlands
| | - A Woolf
- Bone and Joint Research Group, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - C Wyers
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - P Geusens
- Department of Internal Medicine, Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,University Hasselt, Hasselt, Belgium
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18
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Sleath B, Carpenter DM, Blalock SJ, Sayner R, Muir KW, Slota C, Giangiacomo AL, Hartnett ME, Tudor G, Robin AL. Applying the resources and supports in self-management framework to examine ophthalmologist-patient communication and glaucoma medication adherence. HEALTH EDUCATION RESEARCH 2015; 30:693-705. [PMID: 26338986 PMCID: PMC4668753 DOI: 10.1093/her/cyv034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/06/2015] [Indexed: 05/04/2023]
Abstract
Little is known about how ophthalmologist-patient communication over time is associated with glaucoma patient long-term adherence. The purpose of our study was to examine the association between provider use of components of the resources and supports in self-management model when communicating with patients and adherence to glaucoma medications measured electronically over an 8-month period. In this longitudinal prospective cohort study, the main variables studied were ophthalmologist communication-individualized assessment, collaborative goal setting and skills enhancement. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited from six ophthalmology clinics. Patients' baseline and next follow-up visits were videotape-recorded. Patients were interviewed after their visits. Patients used medication event monitoring systems (MEMS) for 8 months after enrollment into the study, and adherence was measured electronically using MEMS for 240 days after their visits. Two hundred and seventy-nine patients participated. Patient race and regimen complexity were negatively associated with glaucoma medication adherence over an 8-month period. Provider communication behaviors, including providing education and positive reinforcement, can improve patient adherence to glaucoma medications over an 8-month period.
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Affiliation(s)
- B Sleath
- UNC Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services Research,
| | - D M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - S J Blalock
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - R Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - K W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham VA Medical Center, Health Services Research and Development, Durham, NC, USA
| | - C Slota
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - A L Giangiacomo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - M E Hartnett
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA
| | - G Tudor
- Department of Science and Mathematics, Director of Institutional Research, Husson University, Bangor, ME 04401, USA
| | - A L Robin
- Department of Ophthalmology, University of Maryland, Baltimore, MD, USA, Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD 21215, USA
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19
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Lems WF. Fracture risk estimation may facilitate the treatment gap in osteoporosis. Ann Rheum Dis 2015; 74:1943-5. [PMID: 26408569 DOI: 10.1136/annrheumdis-2015-208245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 09/06/2015] [Indexed: 11/04/2022]
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20
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Giguere AMC, Labrecque M, Haynes RB, Grad R, Pluye P, Légaré F, Cauchon M, Greenway M, Carmichael PH. Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study. Implement Sci 2014; 9:144. [PMID: 25280742 PMCID: PMC4201673 DOI: 10.1186/s13012-014-0144-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/19/2014] [Indexed: 11/14/2022] Open
Abstract
Background Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice. Methods We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information. Results One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6 ± 1.2, scale 1–7, with 7 being “high”), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P < 0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear “bottom line” statement for each Dbox and access to printed Dboxes in consultation rooms. Conclusions Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0144-6) contains supplementary material, which is available to authorized users.
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Lewiecki EM, Miller PD, Harris ST, Bauer DC, Davison KS, Dian L, Hanley DA, McClung MR, Yuen CK, Kendler DL. Understanding and communicating the benefits and risks of denosumab, raloxifene, and teriparatide for the treatment of osteoporosis. J Clin Densitom 2014; 17:490-5. [PMID: 24206867 DOI: 10.1016/j.jocd.2013.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 09/13/2013] [Accepted: 09/18/2013] [Indexed: 12/11/2022]
Abstract
The number needed to treat is a valuable metric to determine the benefit of therapy, but it must be viewed against the respective number needed to harm. Denosumab and teriparatide (TPTD) have proven antifracture efficacy at vertebral and nonvertebral sites, whereas raloxifene has proven antifracture efficacy at the spine only. Denosumab use has been associated with a small, yet statistically significant, increased incidence of eczema and serious cellulitis. Raloxifene use has been associated with statistically significant increases in the risk of venous thromboembolism and possibly deadly stroke, although not an increase in total strokes. No significant, nontransient adverse events have been reported with TPTD use. When used for the treatment of postmenopausal osteoporosis, denosumab, raloxifene, and TPTD all generally have favorable risk-to-benefit profiles, but therapy-specific contraindications necessitate thoughtful consideration of all available clinical information and individualization of treatment decisions.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA.
| | - Paul D Miller
- Colorado Center for Bone Research, Lakewood, CO, USA
| | - Steve T Harris
- Department of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Douglas C Bauer
- Department of General Internal Medicine, University of California, San Francisco, CA, USA
| | - K Shawn Davison
- Faculty of Graduate Studies, University of Victoria, British Columbia, Canada
| | - Larry Dian
- Prohealth Clinical Research, University of British Columbia, Vancouver Canada
| | - David A Hanley
- Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Chui K Yuen
- Prohealth Clinical Research, University of British Columbia, Vancouver Canada
| | - David L Kendler
- Prohealth Clinical Research, University of British Columbia, Vancouver Canada
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Sleath B, Slota C, Blalock SJ, Sayner R, Carpenter DM, Muir KW, Hartnett ME, Robin AL. Provider use of collaborative goal setting with glaucoma patients. Optom Vis Sci 2014; 91:549-55. [PMID: 24705480 PMCID: PMC4005354 DOI: 10.1097/opx.0000000000000244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications. METHODS English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits videotaped and were interviewed after the visits. The videotapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment. RESULTS Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson χ² = 4.1, p = 0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson χ² = 8.2, p = 0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views on glaucoma than non-African American patients (Pearson χ² = 5.62, p = 0.02). CONCLUSIONS Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views on glaucoma when prescribing treatment for the first time.
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Affiliation(s)
- Betsy Sleath
- *PhD †PhD candidate ‡PharmD §PhD, MSPH ∥MD University of North Carolina Eshelman School of Pharmacy (BS, CS, SJB, RS, DMC), Cecil G. Sheps Center for Health Services Research (BS), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Ophthalmology, School of Medicine, Duke University, Durham, North Carolina (KWM); Durham VA Medical Center, Health Services Research and Development, Durham, North Carolina (KWM); Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (MEH); and Department of International Health, Bloomberg School of Public Health, and Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland (ALR)
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Nadler M, Alibhai S, Catton P, Catton C, Jones J. The impact of bone mineral density testing, fracture assessment, and osteoporosis education in men treated by androgen deprivation for prostate cancer: a pilot study. Support Care Cancer 2014; 22:2409-15. [PMID: 24696083 DOI: 10.1007/s00520-014-2183-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 03/02/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and engage in few healthy bone behaviors (HBBs). A multicomponent intervention was piloted in this population. Changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated. METHODS A pre-post pilot study was performed in a convenience sample of men recruited from the Princess Margaret Cancer Centre. Men were sent personalized letters explaining their dual x-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t tests and McNemar's test were used to assess changes in outcomes. RESULTS A total of 148 men completed the study. There was an increase in OP knowledge (9.7 ± 4.3 to 11.4 ± 3.3, p < 0.0001) and feelings of susceptibility (16.5 ± 4.3 to 17.4 ± 4.7, p = 0.015), but a decrease in total self-efficacy (86.3 ± 22.9 to 81.0 ± 27.6, p = 0.007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p ≤ 0.001), and there was uptake of vitamin D supplementation from 44 % (n = 65) to 68 % (n = 99) (p < 0.0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9 ± 4.3 vs. -0.22 ± 4.2, p = 0.005) compared to men with normal bone density. CONCLUSIONS Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs.
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Affiliation(s)
- Michelle Nadler
- Undergraduate Medicine Program, University of Toronto CREMS Scholar Program, Toronto, ON, Canada,
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Sumner W, Ding E, Fischer ID, Hagen MD. Methods for Performing Survival Curve Quality-of-Life Assessments. Med Decis Making 2014; 34:787-99. [PMID: 24449432 DOI: 10.1177/0272989x13514775] [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: 01/18/2013] [Accepted: 11/02/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many medical decisions involve an implied choice between alternative survival curves, typically with differing quality of life. Common preference assessment methods neglect this structure, creating some risk of distortions. METHODS Survival curve quality-of-life assessments (SQLA) were developed from Gompertz survival curves fitting the general population's survival. An algorithm was developed to generate relative discount rate-utility (DRU) functions from a standard survival curve and health state and an equally attractive alternative curve and state. A least means squared distance algorithm was developed to describe how nearly 3 or more DRU functions intersect. These techniques were implemented in a program called X-Trade and tested. RESULTS SQLA scenarios can portray realistic treatment choices. A side effect scenario portrays one prototypical choice, to extend life while experiencing some loss, such as an amputation. A risky treatment scenario portrays procedures with an initial mortality risk. A time trade scenario mimics conventional time tradeoffs. Each SQLA scenario yields DRU functions with distinctive shapes, such as sigmoid curves or vertical lines. One SQLA can imply a discount rate or utility if the other value is known and both values are temporally stable. Two SQLA exercises imply a unique discount rate and utility if the inferred DRU functions intersect. Three or more SQLA results can quantify uncertainty or inconsistency in discount rate and utility estimates. Pilot studies suggested that many subjects could learn to interpret survival curves and do SQLA. LIMITATIONS SQLA confuse some people. Compared with SQLA, standard gambles quantify very low utilities more easily, and time tradeoffs are simpler for high utilities. When discount rates approach zero, time tradeoffs are as informative and easier to do than SQLA. CONCLUSIONS SQLA may complement conventional utility assessment methods.
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Affiliation(s)
- Walton Sumner
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA (WS, IDF)
| | - Eric Ding
- American Board of Family Medicine, Inc., Lexington, KY, USA (ED, MDH)
| | - Irene D Fischer
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA (WS, IDF)
| | - Michael D Hagen
- American Board of Family Medicine, Inc., Lexington, KY, USA (ED, MDH),Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY, USA (MDH)
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Abstract
Osteoporosis-related fractures (low-trauma, fragility fractures) are associated with significant morbidity, mortality, and health care expenditure worldwide. In the absence of a defining fracture, the diagnosis of osteoporosis is based on the World Health Organization's T-score criteria using central dual-energy x-ray absorptiometry (DXA). Paradoxically, the majority of those patients who will sustain a low-trauma fracture do not meet the T-score definition of osteoporosis. Conversely, younger individuals with bone density in the osteoporotic range but no other risk factors have relatively low fracture rates and yet are frequently considered candidates for osteoporosis therapies. The limited accuracy of bone density testing alone to predict fractures has led to the development of a variety of fracture assessment tools that utilize the combination of bone density and clinical risk factors to improve the prediction of low-trauma fractures. These fracture assessment tools quantitatively predict the 10-year fracture probability of hip and major osteoporosis-related fractures, and can be used to define cost-effective intervention strategies for primary and secondary fracture prevention.
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Affiliation(s)
- Sanford Baim
- Division of Endocrinology, Miller School of Medicine, University of Miami, 1400 NW 10th Avenue, Dominion Towers, Suite 809, Miami, FL 33136, USA.
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Abstract
In almost all patients with incident fractures, the absolute risk of subsequent fracture and mortality is highest immediately after the fracture is incurred; the risk is substantially increased in frail elderly patients. The risk factors for incident fractures, such as bone fragility, tendency to fall and the presence of metabolic bone disease, remain underdiagnosed and undertreated. Here, we review the evidence that demonstrates the influence of these risk factors on susceptibility to subsequent fracture and mortality after an incident fracture, and discuss the tools available to predict these outcomes. In this Review, we also propose a systematic, coordinator-based approach to assessment of risk, allocation of treatment and follow-up in all patients over 50 years of age who present with a fracture. The aim of this proposed multistep procedure is to improve the prevention of secondary fracture, decrease mortality rates and reduce patient undertreatment or overtreatment.
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Lewiecki EM. Safety and tolerability of denosumab for the treatment of postmenopausal osteoporosis. DRUG HEALTHCARE AND PATIENT SAFETY 2011; 3:79-91. [PMID: 22279412 PMCID: PMC3264422 DOI: 10.2147/dhps.s7727] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Denosumab is a fully human monoclonal antibody to receptor activator of nuclear factor kappa-B ligand (RANKL), a cytokine member of the tumor necrosis factor family that is the principal regulator of osteoclastic bone resorption. Postmenopausal osteoporosis (PMO) is a systemic skeletal disease associated with high levels of RANKL, resulting in a high rate of bone remodeling and an imbalance of bone resorption over bone formation. By inhibiting RANKL in women with PMO, denosumab reduces the rate of bone remodeling, thereby increasing bone mineral density, improving bone strength, and reducing the risk of fractures. In clinical trials of women with osteoporosis and low bone mineral density, denosumab has been well tolerated, with overall rates of adverse events and serious adverse events in women treated with denosumab similar to those receiving placebo. In the largest clinical trial of denosumab for the treatment of women with PMO, there was a significantly greater incidence of cellulitis reported as a serious adverse event, with no difference in the overall incidence of cellulitis, and a significantly lower incidence of the serious adverse event of concussions with denosumab compared with placebo. The evidence supports a favorable balance of benefits versus risks of denosumab for the treatment of PMO. Assessments of the long-term safety of denosumab are ongoing. Denosumab 60 mg subcutaneously every 6 months is an approved treatment for women with PMO who are at high risk for fracture.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico, USA
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28
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Abstract
Risk assessment and communication of risk are essential components in the care of patients with osteoporosis. The risk of fracture in an untreated patient can be estimated with measurement of bone mineral density, consideration of clinical risk factors, and the use of a validated fracture risk assessment algorithm. When fracture risk is high, pharmacologic therapy to reduce the risk of fracture is indicated, provided no contraindications are present. Initiation, compliance, and persistence with therapy may be enhanced when the patient fully understands the risk of fracture if no treatment is given, as well as the expected benefit and potential risks of treatment. Optimal clinical outcomes with treatment may in part depend on the clinician's skill in communicating risk with the patient, understanding the patient's concerns, and reaching a collaborative treatment decision that is medically reasonable and acceptable to the patient.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM 87106, USA.
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29
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Abstract
Drugs in the bisphosphonate class are the most commonly prescribed therapeutic agents for the treatment of osteoporosis. Prospective, randomized, placebo-controlled clinical trials have demonstrated efficacy in reducing fracture risk, with favourable safety profiles, in women with postmenopausal osteoporosis. However, long-term use in clinical practice has been associated with reports of undesirable events not previously recognized. These have included gastrointestinal intolerance, osteonecrosis of the jaw, atypical femur fractures, oesophageal cancer, atrial fibrillation and chronic musculoskeletal pain. Physicians must be alert to newly recognized safety concerns, understand the level of evidence supporting them and be able to effectively communicate the balance of expected benefit and potential risk to patients. Usually, post-marketing adverse events are first presented as case reports or observational studies with variable levels of supporting evidence for plausibility, pathophysiology and causality. Widespread coverage in the news media, which can be alarming to patients and their physicians, may not present a balanced view of the proven benefits, the uncertain risks of therapy and the relative magnitude of these events. There may be confusion about the risks associated with bisphosphonate use for the treatment of osteoporosis versus treatment of other conditions, such as cancer, which typically involves a very different patient population and different doses or frequency of drug administration. Often reports of possible adverse events do not provide information on the number of patients exposed to the drug in proportion to the reported adverse event, or do not describe the incidence of the adverse event in a comparator population not exposed to the drug. Gastrointestinal intolerance with oral bisphosphonates, and hypocalcaemia, acute phase reactions and renal toxicity with intravenous bisphosphonates are characterized by biological plausibility and demonstration of causality. Safety concerns with uncertain biological plausibility and unproven causality include osteonecrosis of the jaw, atypical femur fractures, oesophageal cancer and ocular inflammation. Suspected concerns that are unlikely to be causally related include atrial fibrillation and hepatotoxicity. When making the decision to use a bisphosphonate for the treatment of osteoporosis, the balance between benefit and potential risks according to clinical circumstances of each patient should be considered.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico 87106, USA.
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Kleen JL, Atkinson O, Noordhuizen JP. Communication in production animal medicine: modelling a complex interaction with the example of dairy herd health medicine. Ir Vet J 2011; 64:8. [PMID: 21777495 PMCID: PMC3156738 DOI: 10.1186/2046-0481-64-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 07/20/2011] [Indexed: 11/19/2022] Open
Abstract
Background The importance of communication skills in veterinary medicine is increasingly recognised. Appropriate communication skills towards the client are of utmost importance in both companion animal practice and production animal field and consultancy work. The need for building a relationship with the client, alongside developing a structure for the consultation is widely recognised and applies to both types of veterinary practice. Results Veterinary advisory practice in production animal medicine is, however, characterised by a more complex communication on different levels. While the person-orientated communication is a permanent process between veterinarian and client with a rather personal perspective and defines the roles of interaction, the problem-orientated communication deals with emerging difficulties; the objective is to solve an acute health problem. The solution - orientated communication is a form of communication in which both veterinarian and client address longstanding situations or problems with the objective to improve herd health and subsequently productivity performance. All three forms of communication overlap. Conclusions Based on this model, it appears useful for a veterinary practice to offer both a curative and an advisory service, but to keep these two separated when deemed appropriate. In veterinary education, the strategies and techniques necessary for solution orientated communication should be included in the teaching of communication skills.
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Shandro MTL. Evaluating Fracture Risk. Can Pharm J (Ott) 2011. [DOI: 10.3821/1913-701x-144.suppl1.s19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Tami L. Shandro
- Tami Shandro is a family physician who works as part of a multidisciplinary team in the osteoporosis clinic at the Grey Nuns Community Hospital in Edmonton, AB. Contact
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