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A population-based study of postfracture care in Manitoba, Canada 2000/2001–2014/2015

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Abstract

Summary

We previously found that population-based postfracture notification, which informed primary care physicians of their patient’s recent fracture and suggested assessment for osteoporosis, led to an improvement in postfracture care in the context of a randomized controlled trial (ClinicalTrials.gov identifier NCT00594789, fractures from late 2007 to mid-2010). Since June 2010, a province-wide postfracture notification program was implemented. This study was to (1) determine whether this program has resulted in sustained improvement in postfracture care and (2) test factors associated with receiving osteoporosis care.

Methods

A retrospective matched cohort study was performed using population-based health administrative data in Manitoba, Canada. We selected individuals aged 50+ years with an incident major osteoporosis fracture (MOF; N = 18,541) in fiscal years 2000/2001 to 2013/2014 and controls without a MOF (N = 92,705) matched (5:1) on age, sex, and residential area. The Cochran-Armitage test tested for a linear trend in osteoporosis care outcomes for cases and controls. Logistic regressions were used to test characteristics associated with the likelihood of receiving osteoporosis care.

Results

The percentage of individuals receiving DXA testing and/or osteoporosis medication increased in fracture cases (p < 0.001), but decreased in controls (p < 0.001). Odds ratios for osteoporosis care in years following the postfracture notification program were approximately double of those prior to the clinical trial. In addition to prior MOF (OR 9.03, 95% CI 8.60–9.48), factors associated with osteoporosis care included lower income (OR   0.72, 95% CI 0.67–0.78), glucocorticoid use (OR   4.37, 95% CI 3.72–5.14), diabetes diagnosis (OR =  0.74, 95% CI 0.68–0.80), and Charlson Comorbidity Index (indexes 1–2: OR 1.27, 95% CI 1.20–1.34; indexes 3–5: OR 1.26, 95% CI 1.13–1.40).

Conclusions

Adopting a population-based postfracture notification program led to sustained improvements in postfracture care.

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References

  1. Kanis JA, Cooper C, Rizzoli R, Reginster JY, Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF) (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30(1):3–44

    CAS  PubMed  Google Scholar 

  2. Papaioannou A, Kennedy CC, Ioannidis G et al (2009) The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int 20:703–714

    Article  CAS  PubMed  Google Scholar 

  3. Ioannidis G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L, Kennedy CC, Prior JC, Olszynski WP, Davison KS, Goltzman D, Thabane L, Gafni A, Papadimitropoulos EA, Brown JP, Josse RG, Hanley DA, Adachi JD (2009) Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ 181:265–271

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tarride JE, Hopkins RB, Leslie WD, Morin S, Adachi JD, Papaioannou A et al (2012) The burden of illness of osteoporosis in Canada. J Bone Miner Res 27(8):1830–1838

    Article  PubMed  Google Scholar 

  5. Saito T, Sterbenz JM, Malay S, Zhong L, MacEachern MP, Chung KC (2017) Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis. Osteoporos Int 28(12):3289–3300

    Article  CAS  PubMed  Google Scholar 

  6. Murad MH, Drake MT, Mullan RJ, Mauck KF, Stuart LM, Lane MA, Abu Elnour NO, Erwin PJ, Hazem A, Puhan MA, Li T, Montori VM (2012) Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis. J Clin Endocrinol Metab 97(6):1871–1880

    Article  CAS  PubMed  Google Scholar 

  7. Khosla S, Cauley JA, Compston J, Kiel DP, Rosen C, Saag KG, Shane E (2016) Addressing the crisis in the treatment of osteoporosis. J Bone Miner Res 32(3):1929–1937

    Google Scholar 

  8. Harvey NC, McCloskey EV, Mitchell PJ, Dawson-Hughes B, Pierroz DD, Reginster JY et al (2017) Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Osteoporos Int 28(5):1507–1529

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Wu CH, Tu ST, Chang YF, Chan DC, Chien JT, Lin CH, Singh S, Dasari M, Chen JF, Tsai KS (2018) Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Bone. 111:92–100

    Article  PubMed  Google Scholar 

  10. Sale JE, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2011) Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporos Int 22(7):2067–2082

    Article  CAS  PubMed  Google Scholar 

  11. Leslie WD, LaBine L, Klassen P, Dreilich D, Caetano PA (2012) Closing the gap in postfracture care at the population level: a randomized controlled trial. CMAJ 184(3):290–296. https://doi.org/10.1503/cmaj.111158

    Article  PubMed  PubMed Central  Google Scholar 

  12. Roos LL, Soodeen RA, Bond R, Burchill C (2003) Working more productively: tools for administrative data. Health Serv Res 38(5):1339–1357

    Article  PubMed  PubMed Central  Google Scholar 

  13. Roos LL, Roos NP, Cageorge SM, Nicol JP (1982) How good are the data? Reliability of one health care data bank. Med Care 20(3):266–276

    Article  PubMed  Google Scholar 

  14. Kozyrskyj AL, Mustard CA (1998) Validation of an electronic, population-based prescription database. Ann Pharmacother 32(11):1152–1157

    Article  CAS  PubMed  Google Scholar 

  15. Leslie WD, Metge C (2003) Establishing a regional bone density program: lessons from the Manitoba experience. J Clin Densitom 6(3):275–282

    Article  PubMed  Google Scholar 

  16. Leslie WD, Caetano PA, Macwilliam LR, Finlayson GS (2005) Construction and validation of a population-based bone densitometry database. J Clin Densitom 8(1):25–30

    Article  PubMed  Google Scholar 

  17. Lix LM, Azimaee M, Osman BA, Caetano P, Morin S, Metge C, Goltzman D, Kreiger N, Prior J, Leslie WD (2012) Osteoporosis-related fracture case definitions for population-based administrative data. BMC Public Health 12:301

    Article  PubMed  PubMed Central  Google Scholar 

  18. O’Donnell S, Canadian Chronic Disease Surveillance System Osteoporosis Working G (2013) Use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study. Arch Osteoporos 8:143

    Article  PubMed  PubMed Central  Google Scholar 

  19. Epp R, Alhrbi M, Ward L, Leslie WD (2018) Radiological validation of fracture definitions from administrative data. J Bone Miner Res 33(Supp 1):S275

    Google Scholar 

  20. Brownell M, Mayer T, Martens PJ, Kozyrskyj A, Fergusson P, Bodnarchuk J et al (2002) Using a population-based health information system to study child health. Can J Public Health 93(Suppl 2):S9–S14

    Article  PubMed  PubMed Central  Google Scholar 

  21. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43(11):1130–1139

    Article  PubMed  Google Scholar 

  22. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682

    Article  PubMed  Google Scholar 

  23. Lix LM, Yogendran MS, Shaw SY, Burchill C, Metge C, Bond R (2008) Population-based data sources for chronic disease surveillance. Chronic Dis Can 29(1):31–38

    CAS  PubMed  Google Scholar 

  24. SAS Institute Inc (2016) SAS® 9.4 system options: reference, Fifth Edition. SAS Institute Inc., Cary

    Google Scholar 

  25. Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM (2012) A population-based analysis of the post-fracture care gap 1996-2008: the situation is not improving. Osteoporos Int 23(5):1623–1629. https://doi.org/10.1007/s00198-011-1630-1

    Article  CAS  PubMed  Google Scholar 

  26. Leslie WD, Brennan SL, Prior HJ, Lix LM, Metge C, Elias B (2012) The post-fracture care gap among Canadian First Nations peoples: a retrospective cohort study. Osteoporos Int 23(3):929–936

    Article  CAS  PubMed  Google Scholar 

  27. Keshishian A, Boytsov N, Burge R, Krohn K, Lombard L, Zhang X, Xie L, Baser O (2017) Examining the treatment gap and risk of subsequent fractures among females with a fragility fracture in the US Medicare population. Osteoporos Int 28(8):2485–2494

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD, for the Scientific Advisory Council of Osteoporosis Canada (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182(17):1864–1873

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jackuliak P, Payer J (2014) Osteoporosis, fractures, and diabetes. Int J Endocrinol 2014:820615. https://doi.org/10.1155/2014/820615

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Jha S, Wang Z, Laucis N, Bhattacharyya T (2015) Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996-2012: an ecological analysis. J Bone Miner Res 30(12):2179–2187. https://doi.org/10.1002/jbmr.2565

    Article  CAS  PubMed  Google Scholar 

  31. Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Greenspan SL, Wyman A, Hooven FH, Adami S, Gehlbach S, Anderson FA Jr et al (2012) Predictors of treatment with osteoporosis medications after recent fragility fractures in a multinational cohort of postmenopausal women. J Am Geriatr Soc 60(3):455–461

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kim SC, Kim MS, Sanfélix-Gimeno G, Song HJ, Liu J, Hurtado I, Peiró S, Lee J, Choi NK, Park BJ, Avorn J (2015) Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study. Am J Med 128(5):519–526

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bawa HS, Weick J, Dirschl DR (2015) Anti-osteoporotic therapy after fragility fracture lowers rate of subsequent fracture: analysis of a large population sample. J Bone Joint Surg Am 97(19):1555–1562

    Article  PubMed  Google Scholar 

  35. Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 29(9):1929–1937

    Article  PubMed  Google Scholar 

  36. Beaton DE, Mamdani M, Zheng H, Jaglal S, Cadarette SM, Bogoch ER (2017) Improvements in osteoporosis testing and care are found following the wide scale implementation of the Ontario Fracture Clinic Screening Program: an interrupted time series analysis. Medicine. 96(48):e9012

    Article  PubMed  PubMed Central  Google Scholar 

  37. Majumdar SR, Lier DA, Leslie WD (2013) Cost-effectiveness of two inexpensive postfracture osteoporosis interventions: results of a randomized trial. J Clin Endocrinol Metab 98(5):1991–2000

    Article  CAS  PubMed  Google Scholar 

  38. Manitoba Centre for Health Policy (2014) MCHP data quality framework. http://umanitoba.ca/faculties/medicine/units/community_health_sciences/departmental_units/mchp/protocol/media/Data_Quality_Framework.pdf Accessed 17 Nov 2018

  39. Cauley JA (2011) Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res 469(7):1891–1899

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Manitoba Population Research Data Repository under HIPC# 2008/2009-16 [Theme 4]. The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors & Active Living, or other data providers is intended or should be inferred. This article has been reviewed and approved by the Manitoba Bone Density Program Committee.

Author information

Authors and Affiliations

  1. George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada

    Y. Cui & L. M. Lix

  2. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

    Y. Cui & L. M. Lix

  3. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China

    S. Yang

  4. Department of Medicine, McGill University, Montreal, Quebec, Canada

    S. N. Morin

  5. Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada

    W. D. Leslie

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Corresponding author

Correspondence to W. D. Leslie.

Ethics declarations

This study was approved by the Health Research Ethics Board at the University of Manitoba and Manitoba Health Information Privacy Committee.

Conflicts of interest

Suzanne Morin: Nothing to declare for the context of this paper, but has received research grants: Amgen, Merck.

Yang Cui, Lisa Lix, Shuman Yang, William Leslie: No conflicts of interest.

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Cui, Y., Lix, L.M., Yang, S. et al. A population-based study of postfracture care in Manitoba, Canada 2000/2001–2014/2015. Osteoporos Int 30, 2119–2127 (2019). https://doi.org/10.1007/s00198-019-05074-8

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