Abstract
Summary
Most patients are not treated for osteoporosis after their fragility fracture “teachable moment.” Among almost 400 consecutive wrist fracture patients, we determined that better-than-average osteoporosis knowledge (adjusted odds = 2.6) and BMD testing (adjusted odds = 6.5) were significant modifiable facilitators of bisphosphonate treatment while male sex, working outside the home, and depression were major barriers.
Introduction
In the year following fragility fracture, fewer than one quarter of patients are treated for osteoporosis. Although much is known regarding health system and provider barriers and facilitators to osteoporosis treatment, much less is understood about modifiable patient-related factors.
Methods
Older patients with wrist fracture not treated for osteoporosis were enrolled in trials that compared a multifaceted intervention with usual care controls. Baseline data included a test of patient osteoporosis knowledge. We then determined baseline factors that independently predicted starting bisphosphonate treatment within 1 year.
Results
Three hundred seventy-four patients were enrolled; mean age 64 years, 78 % women, 90 % white, and 54 % with prior fracture. Within 1 year, 86 of 374 (23 %) patients were treated with bisphosphonates. Patients who were treated had better osteoporosis knowledge at baseline (70 % correct vs 57 % for untreated, p < 0.001) than patients who remained untreated; conversely, untreated patients were more likely to be male, still working, and report depression. In fully adjusted models, osteoporosis knowledge was independently associated with starting bisphosphonates (adjusted OR 2.6, 95 %CI 1.3–5.3). Obtaining a BMD test (aOR 6.5, 95 %CI 3.4–12.2) and abnormal BMD results (aOR 34.5, 95 %CI 16.8–70.9) were strongly associated with starting treatment.
Conclusions
The most important modifiable facilitators of osteoporosis treatment in patients with fracture were knowledge and BMD testing. Specifically targeting these two patient-level factors should improve post-fracture treatment rates.
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Conflicts of interest
SR Majumdar, FA McAlister, JA Johnson, DL Weir, D Bellerose, DA Hanley, AS Russell, and BH Rowe declare that they have no conflicts of interest with respect to this study. The corresponding author (SRM) had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors were involved in conception and design and analysis and interpretation and provided critical revision to manuscript drafts. DL also undertook statistical analyses. SRM also wrote the first draft, obtained funding, and supervised the study.
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Peer-reviewed operating grants from the Canadian Institutes of Health Research (CIHR) and the Alberta Heritage Foundation for Medical Research. SRM, FAM, and JAJ hold salary awards from Alberta Innovates—Health Solutions; SRM holds the Endowed Chair in Patient Health Management from the Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta; FAM holds the University of Alberta Chair in Cardiovascular Outcomes Research; and JAJ and BHR hold CIHR-Canada Research Chairs.
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Majumdar, S.R., McAlister, F.A., Johnson, J.A. et al. Critical impact of patient knowledge and bone density testing on starting osteoporosis treatment after fragility fracture: secondary analyses from two controlled trials. Osteoporos Int 25, 2173–2179 (2014). https://doi.org/10.1007/s00198-014-2728-z
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DOI: https://doi.org/10.1007/s00198-014-2728-z