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Marwayani, Hadju V, Nursyamsi I. Analysis of integrated health referral systems in the era of regional autonomy in West Sulawesi. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Narla RR, Hirano LA, Lo SHY, Anawalt BD, Phelan EA, Matsumoto AM. Suboptimal osteoporosis evaluation and treatment in older men with and without additional high-risk factors for fractures. J Investig Med 2019; 67:743-749. [PMID: 30723121 DOI: 10.1136/jim-2018-000907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 01/05/2023]
Abstract
We compared osteoporosis case-finding, evaluation and treatment in groups of Older Men and Older Women with age alone as a significant risk for fracture and Older Men with Higher Risk (older men additionally having previous hip fracture, corticosteroid use or androgen deprivation therapy). We studied 13,704 older men and women (≥70 years old) receiving care at a Veterans Affairs medical center from January 2000 to August 2010 whose 10-year hip fracture risk was assessed by limited FRAX score. The main outcome measures were the proportion of patients who had bone mineral density (by dual-energy X-ray absorptiometry [DXA]) and serum 25-hydroxy vitamin D (25-OH D) measurements performed, and calcium/vitamin D or bisphosphonates prescribed. The proportion of men with a 10-year hip fracture risk ≥3% with age alone as a risk was 48% and 88% in men aged 75-79 and ≥80 years, respectively. Compared with Older Women, fewer Older Men underwent DXA (12% vs 63%, respectively) and 25-OH D measurements (18% vs 39%), and fewer received calcium/vitamin D (20% vs 63%) and bisphosphonate (5% vs 44%) prescriptions. In Older Men with Higher Risk category, the proportion of men with 10-year hip fracture risk ≥3% ranged from 69% to 95%. Despite a higher risk and expectation that this group would have greater case detection and screening, few Older Men with Higher risk underwent DXA screening (27%-36%) and 25-OH D measurements (23%-28%), and received fewer calcium/vitamin D (40%-50%) and bisphosphonate (13%-24%) prescriptions. Considering the known morbidity and mortality, our findings underscore the need for improved evaluation and management of osteoporosis in older men at high risk for fracture.
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Affiliation(s)
- Radhika Rao Narla
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA.,Division of Endocrinology, Metabolism and Nutrition, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Lianne A Hirano
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Serena H Y Lo
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bradley D Anawalt
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Elizabeth A Phelan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Alvin M Matsumoto
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
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Lawrence PT, Grotzke MP, Rosenblum Y, Nelson RE, LaFleur J, Miller KL, Ma J, Cannon GW. The Bone Health Team: A Team-Based Approach to Improving Osteoporosis Care for Primary Care Patients. J Prim Care Community Health 2017; 8:135-140. [PMID: 28093017 PMCID: PMC5932690 DOI: 10.1177/2150131916687888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Significant improvements in secondary prevention of osteoporotic fractures have been noted with fracture liaison services. However, similar models for the primary prevention of such fractures have not been reported. OBJECTIVE To determine the impact of a Bone Health Team (BHT) on osteoporosis screening and treatment rates in U.S. veterans in primary care practices. DESIGN Historical cohort study of a primary care-based intervention of a BHT from February 2013 to February 2015. SETTING Community-based outpatient clinics of the Salt Lake City Veterans Affairs Health Care System. PARTICIPANTS Men aged 70 years and older and women aged 65 years and older. INTERVENTION Enrollment in the BHT. MEASUREMENTS Rates of dual energy x-ray absorptiometry (DXA) completion, chart diagnosis of osteoporosis or osteopenia, completion of vitamin D measurement, and initiation of fracture reducing medication. RESULTS Our cohort consisted of 7644 individuals, 975 of whom were exposed to the BHT and 6669 of whom were not. Comparison of patients exposed to the BHT versus non-exposed subjects demonstrated a substantial increase in all outcome measures studied. Hazard ratios (HRs) from multivariable cox proportional hazard models were: measurement of vitamin D, HR = 1.619 ( P < .001); chart diagnosis of osteopenia, HR = 37.00 ( P < .001); chart diagnosis of osteoporosis, HR = 16.38 ( P < .001); osteoporosis medication, HR = 17.03 ( P < .001); and completion of DXA, HR = 139.9 ( P < .001). CONCLUSIONS AND RELEVANCE The implementation of a dedicated BHT produced significantly increased rates of intermediate osteoporosis outcome measures in US veterans in primary care practices. Additional research describing medication adherence rates and cost-effectiveness is forthcoming.
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Affiliation(s)
- Phillip T. Lawrence
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Roseman University of Health Sciences, South Jordan, UT, USA
| | - Marissa P. Grotzke
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, UT, USA
| | - Yanina Rosenblum
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Richard E. Nelson
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, UT, USA
| | - Joanne LaFleur
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, UT, USA
| | - Karla L. Miller
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, UT, USA
| | - Junjie Ma
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, UT, USA
| | - Grant W. Cannon
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, UT, USA
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Lin J, Yang Y, Fei Q, Zhang X, Ma Z, Wang Q, Li J, Li D, Meng Q, Wang B. Validation of three tools for identifying painful new osteoporotic vertebral fractures in older Chinese men: bone mineral density, Osteoporosis Self-Assessment Tool for Asians, and fracture risk assessment tool. Clin Interv Aging 2016; 11:461-9. [PMID: 27217730 PMCID: PMC4853018 DOI: 10.2147/cia.s101078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This cross-sectional study compared three tools for predicting painful new osteoporotic vertebral fractures (PNOVFs) in older Chinese men: bone mineral density (BMD), the Osteoporosis Self-Assessment Tool for Asians (OSTA), and the World Health Organization fracture risk assessment tool (FRAX) (without BMD). METHODS Men aged ≥50 years were apportioned to a group for men with fractures who had undergone percutaneous vertebroplasty (n=111), or a control group of healthy men (n=385). Fractures were verified on X-ray and magnetic resonance imaging. BMD T-scores were determined by dual energy X-ray absorptiometry. Diagnosis of osteoporosis was determined by a BMD T-score of ≤2.5 standard deviations below the average for a young adult at peak bone density at the femoral neck, total hip, or L1-L4. Demographic and clinical risk factor data were self-reported through a questionnaire. BMD, OSTA, and FRAX scores were assessed for identifying PNOVFs via receiver-operating characteristic (ROC) curves. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. RESULTS Between the men with fractures and the control group, there were significant differences in BMD T-scores (at femoral neck, total hip, and L1-L4), and OSTA and FRAX scores. In those with fractures, only 53.15% satisfied the criteria for osteoporosis. Compared to BMD or OSTA, the FRAX score had the best predictive value for PNOVFs: the AUC of the FRAX score (cutoff =2.9%) was 0.738, and the sensitivity and specificity were 82% and 62%, respectively. CONCLUSION FRAX may be a valuable tool for identifying PNOVFs in older Chinese men.
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Affiliation(s)
- JiSheng Lin
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Qi Fei, Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Yongan Road 95#, Xicheng District, Beijing 100050, People’s Republic of China, Tel +86 10 6313 8353, Fax +86 10 8391 1029, Email
| | - XiaoDong Zhang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhao Ma
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qi Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - JinJun Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Dong Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qian Meng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - BingQiang Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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