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Patients reject the concept of fragility fracture—a new understanding based on fracture patients’ communication

Osteoporosis International volume 23, pages 2829–2834 (2012)Cite this article

Abstract

Summary

We examined patients’ communication about fragility fractures to gain insight into why patients do not connect fractures to bone health. The term “fragility” fracture was a misnomer to patients who perceived the event as physically and emotionally traumatic. Improved communication about such fractures could facilitate awareness of bone health.

Introduction

We examined patients’ communication about fragility fractures to gain insight into why patients do not perceive the connection between their fracture and low bone mass.

Methods

A descriptive phenomenological (qualitative) study was conducted. During face-to-face interviews, the participants described the experience of their fracture in detail and the circumstances surrounding the fracture. Data analysis was guided by Giorgi’s methodology. English-speaking male and female patients aged 65+ years and “high” risk for future fracture were eligible and screened for osteoporosis through an established screening program at an urban teaching hospital.

Results

We recruited 30 participants (9 males, 21 females), aged 65–88, who presented with a hip (n = 11), wrist (n = 11), shoulder (n = 6), or other (n = 2) fracture. Ten of the 30 fractures occurred inside the home and the remaining fractures occurred outside the home. Sustaining a fragility fracture was perceived as a traumatic event, both physically and emotionally. In general, participants used forceful, action-oriented words and referred to hard surfaces to describe the experience. Explanations for the fracture, other than bone quality, were often reported, especially that falls were “freak” or “fluke” events. Patients who sustained a fracture under more mundane circumstances seemed more likely to perceive a connection between the fracture and their bone health.

Conclusions

The term fragility fracture was a misnomer for many older adults. By reexamining how this term is communicated to fracture patients, health care providers may better facilitate patients’ awareness of bone health.

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References

  1. World Health Organization (1994) Assessment of fracture risk and application to screening for postmenopausal osteoporosis. WHO Technical Report Series, Geneva

    Google Scholar 

  2. Barrett-Connor E, Sajjan SG, Siris ES, Miller PD, Chen Y-T, Markson LE (2008) Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 19:607–613

    PubMed  Article  CAS  Google Scholar 

  3. Berry SD, Samelson EJ, Hannan MT, McLean RR, Lu M, Cupples LA et al (2007) Second hip fracture in older men and women: the Framingham Study. Arch Intern Med 167(18):1971–1976

    PubMed  Article  Google Scholar 

  4. Kanis JA, Johnell O, De LC, Johansson H, Oden A, Delmas P et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382

    PubMed  Article  CAS  Google Scholar 

  5. Meadows LM, Mrkonjic LA, Petersen KMA, Lagendyk LE (2004) After the fall: women’s views of fractures in relation to bone health at midlife. Women Health 39(2):47–62

    PubMed  Article  Google Scholar 

  6. Meadows LM, Mrkonjic LA (2003) Breaking—bad news: women’s experiences of fractures at midlife. Can J Public Health 94(6):427–430

    PubMed  Google Scholar 

  7. Giangregorio L, Dolovich L, Cranney A et al (2009) Osteoporosis risk perceptions among pateints who have sustained a fragility fracture. Patient Educ Couns 74:213–220

    PubMed  Article  Google Scholar 

  8. Sale JEM, Beaton DE, Sujic R, Bogoch ER (2010) “If it was osteoporosis, I would have really hurt myself”. Ambiguity about osteoporosis and osteoporosis care despite a screening program to educate fracture patients. J Eval Clin Pract 16(3):590–596

    PubMed  Google Scholar 

  9. Sale JEM, Beaton D, Fraenkel L, Elliot-Gibson V, Bogoch E (2010) The BMD muddle: the disconnect between bone densitometry results and perception of bone health. J Clin Densitom 13(4):370–378

    PubMed  Article  Google Scholar 

  10. Siris ES, Harris ST, Rosen CJ et al (2006) Adherence to biophosphonates therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81(8):1013–1022

    PubMed  Article  Google Scholar 

  11. 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

    PubMed  Article  CAS  Google Scholar 

  12. Rabenda V, Vanoverloop J, Fabri V, Mertens R, Sumkay R, Vannecke C et al (2008) Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg (Am) 90(10):2142–2148

    Article  Google Scholar 

  13. Becker MH (1974) The health belief model and personal health behavior. Health Educ Monogr 2:324–508

    Google Scholar 

  14. Becker MH, Maiman LA (1975) Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care 13(1):10–24

    PubMed  Article  CAS  Google Scholar 

  15. Prochaska JO, DiClemente CC (1983) Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 51:390–395

    PubMed  Article  CAS  Google Scholar 

  16. Tischler L, Hobson S (2005) Fear of falling: a qualitative study among community-dwelling older adults. Phys Occup Ther Geriatr 23(4):37–53

    Article  Google Scholar 

  17. Lee F, Mackenzie L, James C (2008) Perceptions of older people living in the community about their fear of falling. Disabil Rehabil 30(23):1803–1811

    PubMed  Article  Google Scholar 

  18. Gray-Miceli D, Johnson J, Strumpf N (2005) A stepwise approach to a comprehensive post-fall assessment. Ann Long Term Care 13(12):16–24

    Google Scholar 

  19. Yardley L, Donovan-Hall M, Francis K, Todd C, Yardley L, Donovan-Hall M et al (2006) Older people’s views of advice about falls prevention: a qualitative study. Health Educ Res 21(4):508–517

    PubMed  Article  CAS  Google Scholar 

  20. Kampa RJ, Pang J, Gleeson R (2006) Broken bones and fractures—an audit of patients’ perceptions. Ann R Coll Surg Engl 88:663–666

    PubMed  Article  CAS  Google Scholar 

  21. Morse JM (1994) Designing funded qualitative research. In: Denzin NK, Lincoln YS (eds) Handbook of qualitative research. Sage, Thousand Oaks, pp 220–235

    Google Scholar 

  22. Polkinghorne DE (1989) Phenomenological research methods. In: Valle RS, Halling S (eds) Existential-phenomenological perspectives in psychology. Plenum, New York, pp 41–60

    Chapter  Google Scholar 

  23. Giorgi A (2009) The descriptive phenomenological method in psychology: a modified Husserlian approach. Duquesne University Press, Pittsburgh

    Google Scholar 

  24. Siminoski K, Leslie WD, Frame H, Hodsman A, Josse RG, Khan A et al (2005) Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 56(3):178–188

    PubMed  Google Scholar 

  25. Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 88(1):25–34

    PubMed  Article  Google Scholar 

  26. Kvale S (1996) Interviews: an introduction to qualitative research interviewing. Sage, Thousand Oaks

    Google Scholar 

  27. Giorgi A (2008) Concerning a serious misunderstanding of the essence of the phenomenological method in psychology. J Phenomenol Psychol 39:33–58

    Article  Google Scholar 

  28. Wertz FJ (2005) Phenomenological research methods for counseling psychology. J Counsel Psychol 52(2):167–177

    Article  Google Scholar 

  29. Moustakas C (1994) Phenomenological research methods. Sage, Thousand Oaks

    Google Scholar 

  30. Gearing RE (2004) Bracketing in research: a typology. Qual Health Res 14(10):1429–1452

    PubMed  Article  Google Scholar 

  31. Nvivo [computer program]. Victoria, Australia: Qualitative Solutions and Research Pty Ltd.; 2008.

  32. Giorgi A (1989) Some theoretical and practical issues regarding the psychological phenomenological method. Saybrook Review 7:71–85

    Google Scholar 

  33. Giorgi A (1997) The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure. J Phenomenol Psychol 28:235–260

    Article  Google Scholar 

  34. Creswell JW (1998) Qualitative inquiry and research design: choosing among five traditions. Sage, Thousand Oaks

    Google Scholar 

  35. Simpson JM, Darwin C, Marsh N, Simpson JM, Darwin C, Marsh N (2003) What are older people prepared to do to avoid falling? A qualitative study in London. Br J Community Nurs 8(4):152–159

    PubMed  Google Scholar 

  36. Braun BL, Braun BL (1998) Knowledge and perception of fall-related risk factors and fall-reduction techniques among community-dwelling elderly individuals. Phys Ther 78(12):1262–1276

    PubMed  CAS  Google Scholar 

  37. Meadows LM, Mrkonjic LA, O’Brien MD, Tink W (2007) The importance of communication in secondary fragility fracture treatment and prevention. Osteoporos Int 18:159–166

    PubMed  Article  CAS  Google Scholar 

  38. Sale JE, Gignac M, Hawker G (2006) How “bad” does the pain have to be? A qualitative study examining adherence to pain medication in older adults with osteoarthritis. Arthritis Rheum 55(2):272–278

    PubMed  Article  Google Scholar 

  39. Barker KL, Reid M, Minns Lowe CJ, Barker KL, Reid M, Minns Lowe CJ (2009) Divided by a lack of common language? A qualitative study exploring the use of language by health professionals treating back pain. BMC Musculoskelet Disord 10:123

    PubMed  Article  Google Scholar 

  40. Maclean N, Pound P, Wolfe C, Rudd A, Maclean N, Pound P et al (2002) The concept of patient motivation: a qualitative analysis of stroke professionals' attitudes. Stroke 33(2):444–448

    PubMed  Article  Google Scholar 

  41. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB (2000) Evidence-based medicine: how to practice and teach EBM, 2nd edn. Churchill Livingstone, London

    Google Scholar 

  42. McBride CM, Emmons KM, Lipkus IM (2003) Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 18(2):156–170

    PubMed  Article  CAS  Google Scholar 

  43. Papaioannou A, Leslie WD, Morin S, Atkinson S, Brown J, Cheung AM, et al. (2010) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J 2010;doi:10.1503/cmaj.100771.

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Acknowledgments

This study was funded by the Canadian Institutes of Health Research (grant # CGA-86802) and the Ontario Ministry of Health and Long-Term Care (MOHLTC). The views expressed reflect those of the authors and not those of the MOHLTC. Patients were recruited through the Osteoporosis Exemplary Care Program at St. Michael’s Hospital in Toronto.

Conflicts of interest

None.

Author information

Affiliations

  1. Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s, 30 Bond Street, Toronto, ON, Canada, M5B 1W8

    J. E. M. Sale, L. Frankel, D. Beaton & V. Elliot-Gibson

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    J. E. M. Sale, G. Hawker & D. Beaton

  3. Toronto Western Research Institute, University Health Network, Toronto, ON, Canada

    M. A. Gignac

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    M. A. Gignac

  5. Department of Medicine, University of Toronto, Toronto, ON, Canada

    G. Hawker

  6. Osteoporosis Research Program, Women’s College Hospital, Toronto, ON, Canada

    G. Hawker

  7. Mobility Program, St. Michael’s, Toronto, ON, Canada

    E. Bogoch

  8. Department of Surgery, University of Toronto, Toronto, ON, Canada

    E. Bogoch

Authors
  1. J. E. M. Sale
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  2. M. A. Gignac
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  3. L. Frankel
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  4. G. Hawker
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  5. D. Beaton
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  6. V. Elliot-Gibson
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  7. E. Bogoch
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Corresponding author

Correspondence to J. E. M. Sale.

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Sale, J.E.M., Gignac, M.A., Frankel, L. et al. Patients reject the concept of fragility fracture—a new understanding based on fracture patients’ communication. Osteoporos Int 23, 2829–2834 (2012). https://doi.org/10.1007/s00198-012-1914-0

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  • DOI: https://doi.org/10.1007/s00198-012-1914-0

Keywords

  • Communication
  • Fragility fracture
  • Osteoporosis
  • Patient perspective
  • Qualitative research