Original Article

Osteoporosis International

, Volume 25, Issue 1, pp 289-296

Factors influencing the pharmacological management of osteoporosis after fragility fracture: results from the Ontario Osteoporosis Strategy’s fracture clinic screening program

  • D. E. BeatonAffiliated withMobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St Michael’s HospitalInstitute for Work and HealthHealth Policy Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto Email author 
  • , S. DyerAffiliated withMobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St Michael’s Hospital
  • , D. JiangAffiliated withDepartment of Community Health Sciences, Faculty of Medicine, University of Manitoba
  • , R. SujicAffiliated withMobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St Michael’s Hospital
  • , M. SlaterAffiliated withDepartment of Family Medicine, Li Ka Shing Knowledge Institute, St Michael’s Hospital
  • , J. E. M. SaleAffiliated withMobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St Michael’s Hospital
  • , E. R. BogochAffiliated withMobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St Michael’s HospitalDepartment of Surgery, University of Toronto
  • , The Osteoporosis Fracture Clinic Screening Program Evaluation Team

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Abstract

Summary

Potential mediating factors in the pathway to initiation of osteoporosis treatment following a fragility fracture were evaluated. Patients’ perceived need for treatment, mediated by their perception of bone density test results, was central to treatment initiation. Interventions focusing on patients’ perceptions of need and test results may improve treatment rates.

Introduction

We tested a hypothesized pathway to osteoporosis (OP) pharmacotherapy initiation in fragility fracture patients. We hypothesized that bone mineral density (BMD) testing is strongly associated with treatment initiation and perception of BMD test results would inform patients’ perceived need for treatment, which would mediate the effect between BMD testing and treatment initiation.

Methods

A longitudinal cohort study followed patients, ≥50 years of age, screened for fragility fracture in 31 fracture clinics in Ontario, Canada who had no prior diagnosis of or treatment for OP. At screening, OP risk factors, baseline-patient perception of OP risk, OP knowledge, and perceived benefits of medication were reported by patients. Patients were followed up within 6 months of fracture to determine BMD testing and prescription of and adherence to first-line OP pharmacotherapy. Structural equation modeling tested the hypothesized pathway. Significance and magnitude of the coefficients and indicators of overall model fit were used to test our model.

Results

The direct path from BMD testing to OP treatment initiation was non-significant. The pathway to treatment initiation was mediated by patients’ perception of their need, which was influenced by their self-reported BMD results. Baseline fracture risk factors, knowledge of OP, and perceived benefits of treatment-predicted patient-perceived need for treatment at follow-up and initiation of OP treatment.

Conclusions

Patient perceptions were central factors in the path to initiation of OP pharmacotherapy. Interventions to facilitate accurate patient perceptions of BMD test results and OP risk status could prove helpful in improving OP treatment initiation.

Keywords

Fragility fracture Osteoporosis Patient-perceived need Pharmacotherapy Treatment initiation