Abstract
Summary
We examined the clinical characteristics of patients who underwent initial dual energy X-ray absorptiometry (DXA) testing at a primary care facility from 2000 to 2013, and whether these factors changed over time in accordance with Canadian clinical practice guidelines. The burden of osteoporosis remains high and largely unchanged and clinical practice guidelines are not being followed, overall.
Purpose
This study examined the clinical risk factors, therapeutic health behaviors, and bone mineral density (BMD) status of patients who underwent initial DXA testing at a primary care facility in Saskatchewan, Canada, and whether these factors changed over time from 2000 to 2013 in accordance with Canadian clinical practice guidelines.
Methods
We conducted a retrospective cross-sectional medical chart audit of 800 patients 50 years of age and older who underwent their first DXA test to assess BMD status. Data was extracted from 2000 to 2013 and further stratified into four periods (2000–2001, 2002–2006, 2007–2009, and 2010–2013; n = 200 each period) based on the years when practice guidelines were implemented. Extracted data included BMD outcomes, clinical risk factor indicators for DXA testing, and recommendations for therapeutic health behaviors outlined in the clinical practice guidelines.
Results
There were no differences in BMD status across the four time stratas (p = 0.430). Overall, most clinical risk factors had little change over time. The number of males screened significantly increased over time (p < 0.05), and osteoporosis drug therapy use decreased from 2000–2001 to 2010–2013 (p < 0.001). Increasing age, body mass <60 kg, and history of adult fracture were significant independent predictors of osteoporosis diagnosis.
Conclusions
The burden of osteoporosis remains high and largely unchanged in Saskatchewan, Canada. These results serve to inform strategies to enhance health-care provider awareness and compliance with practice guidelines, as well as improve screening rates and patient health behaviors.
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References
Osteoporosis Canada (2014) Osteoporosis and you. http://www.osteoporosis.ca/osteoporosis-and-you/ Accessed 12 Nov 2014
Tarride JE, Hopkins RB, Leslie WD, Morin S, Adachi JD, Papaioannou A et al (2012) The burden of illness of osteoporosis in Canada. Osteoporos Int 23:2591–2600. doi:10.1007/s00198-012-1931-z
Brennan RM, Wactawski-Wende J, Crespo CJ, Dmochowski J (2004) Factors associated with treatment initiation after osteoporosis screening. Am J Epidemiol 160:475–483
McLeod KM, McCann SE, Horvath PJ, Wactawski-Wende J (2007) Predictors of change in calcium intake in postmenopausal women after osteoporosis screening. J Nutr 137:1968–1973
Papaioannou A, Kennedy CC, Ioannidis G, Gao Y, Sawka AM, Goltzman D, Tenenhouse A, Pickard L, Olszynski WP, Davison KS, Kaiser S, Josse RG, Krieger N, Hanley DA, Prior JC, Brown JP, Anastassiades T, Adachi JD (2008) The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19:581–587. doi:10.1007/s00198-007-0483-0
Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(10):S1–S34
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 (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182(17):1864–1873
Brown JP, Fortier M, Frame H, Lalonde A, Papaioannou A, Senikas V, Yuen CK, Osteoporosis Guidelines Committee (2006) Canadian Consensus Conference on osteoporosis, 2006 update. J Obstet Gynaecol Can 28(2 Suppl 1):S95–S112
Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305
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. doi:10.1503/cmaj.111158
Metge CG, Leslie WD, Manness L-J, Yogendran M, Yuen CK, Kvern B (2008) Postfracture care for older women: gaps between optimal care and actual care. Can Fam Physician 54:1270–1276
Cheng N, Green ME (2008) Osteoporosis screening for men. Can Fam Physician 54:1140–1141
Poliquin S, Joseph L, Gray-Donald K (2009) Calcium and vitamin D intakes in an adult Canadian population. Can J Diet Pract Res 70:21–27. doi:10.3148/70.1.2009.21
Vatanparast H, Dolega-Cieszkowski JH, Whiting S (2009) Many adult Canadians are not meeting current calcium recommendations from food and supplement intake. Appl Physiol Nutr Metab 34:191–196
Jiwa F, Foley JM, Theriault D, Siminoski K, Morin S, Kapoor R et al (2008) Breaking barriers not bones: 2008 National Report Card on Osteoporosis Care. Osteoporosis Canada, Toronto
Statistics Canada. Annual demographic estimates: Canada, provinces, and territories, 2012, Cat. No. 91-215-X
Berger C, Langsetmo L, Joseph L, Hanley D, Davison K, Josse R et al (2008) Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents. CMAJ 178:1660–1668
Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD (2007) Low bone mineral density and fracture burden in postmenopausal women. CMAJ 177(6):575–580
Hawker G, Mendel A, Lam MA et al (2012) A clinical decision rule to enhance targeted bone mineral density testing in healthy mid-life women. Osteoporos Int 23:1931–1938. doi:10.1007/s00198-011-1862-0
North American Menopause Society (2010) Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 17:25–54. doi:10.1097/gme.0b013e3181c617e6
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767
Jiang HX, Majumdar SR, Dick DA et al (2005) Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res 20(3):494–500
Leslie WD, Lix LM, Langsetmo L, Berger C, Goltzman D, Hanley DA, Adachi JD, Johansson H, Oden A, McCloskey E, Kanis JA (2011) Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment. Osteoporos Int 22(3):817–827. doi:10.1007/s00198-010-1464-2
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. doi:10.1002/jbmr.2565
Osteoporosis Canada (2014) Make the first break the last with Fracture Liaison Services. http://www.osteoporosis.ca/fracture-liaison-service/ Accessed 12 Nov 2014
Jaglal SB, Donescu OS, Bansod V, Laprade J, Thorpe K, Hawker G, Majumdar SR, Meadows L, Cadarette SM, Papaioannou A, Kloseck M, Beaton D, Bogoch E, Zwarenstein M (2012) Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial. Osteoporos Int 23(1):87–95. doi:10.1007/s00198-011-1726-7
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McLeod, K.M., Johnson, S., Charturvedi, R. et al. Bone mineral density screening and its accordance with Canadian clinical practice guidelines from 2000–2013: an unchanging landscape in Saskatchewan, Canada. Arch Osteoporos 10, 20 (2015). https://doi.org/10.1007/s11657-015-0227-2
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DOI: https://doi.org/10.1007/s11657-015-0227-2