A Survey of Women's Awareness of and Reasons for Lack of Postfracture Osteoporotic Care

Boudreau, Denise M.; Yu, Onchee; Balasubramanian, Akhila; Wirtz, Heidi S.; Grauer, Andreas; Crittenden, Daria B.; Scholes, Delia

doi:10.1111/jgs.14921

Cited by 20 publications

(18 citation statements)

References 49 publications

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“…(25) Furthermore, because of the expense of long-term care in the US, 80% of those patients became destitute. (32) Thus, they are not likely to take appropriate steps to address their risk. (25,31) Most patients do not realize that they are at risk for another fracture, that osteoporosis caused their fracture, and that interventions can reduce their risk.…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

“…(25,31) Most patients do not realize that they are at risk for another fracture, that osteoporosis caused their fracture, and that interventions can reduce their risk. (32) Thus, they are not likely to take appropriate steps to address their risk. (33) To communicate riskrelated messages effectively, all health care professionals should provide consistent and sustained messaging throughout the care pathway, beginning at time of diagnosis and continuing repeatedly.…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

“…These conditions have received a great deal of media attention and some survey data suggest that the risks of anti-osteoporosis drugs are overestimated. (32) Because of the importance of this issue to patients, it is important for prescribing physicians to be aware of the evidence and to be sure it is accurately communicated to their patients.…”

Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

See 2 more Smart Citations

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

171

111

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Osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first‐line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

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Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

See 1 more Smart Citation

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

171

111

View full text Add to dashboard Cite

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“…A Medicare analysis of 145,185 individuals with a fragility fracture found that only 30% received treatment over 12 months following the fracture, whereas a survey of women with a prior fracture estimated that the rate could be as low as 16%. (–) In order for the previous gains seen in fracture prevention to continue, preventive measures and therapies must be utilized effectively.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs in the United States

et al. 2019

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In the United States, osteoporosis affects over 10 million adults, has high societal costs ($22 billion in 2008), and is currently being underdiagnosed and undertreated. Given an aging population, this burden is expected to rise. We projected the fracture burden in US women by modeling the expected demographic shift as well as potential policy changes. With the anticipated population aging and growth, annual fractures are projected to increase from 1.9 million to 3.2 million (68%), from 2018 to 2040, with related costs rising from $57 billion to over $95 billion. Policy‐driven expansion of case finding and treatment of at‐risk women could lower this burden, preventing 6.1 million fractures over the next 22 years while reducing payer costs by $29 billion and societal costs by $55 billion. Increasing use of osteoporosis‐related interventions can reduce fractures and result in substantial cost‐savings, a rare and fortunate combination given the current landscape in healthcare policy. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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“…Regardless of primary care expertise, practitioners cannot compel patients to report for DXA or initiate pharmacotherapy if patients do not attribute fracture to osteoporosis or consider osteoporosis to be a significant health concern, a phenomenon noted by others. 52,53 While participants in these studies on the whole were receptive to DXA and many had undergone post-fracture imaging, they demonstrated limited knowledge of DXA and its role in bone health management. Poor patient knowledge is compounded by reported inconsistent provider messaging and misinformation, reinforcing a point made by others regarding the importance of clinical ownership of bone health care.…”

Section: The Role Of Primary Care In Engaging Patient Use Of Dxamentioning

confidence: 99%

Metasynthesis of Patient Attitudes Toward Bone Densitometry

et al. 2018

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Minimal knowledge exists of patient perceptions and experiences of DXA among those who are fracture naïve: Prior research has focused primarily on secondary fracture prevention contexts. Our metasynthesis reveals patients' significant reliance, given their limited risk appraisal and knowledge, upon primary care providers in decision-making. We urge colleagues to conduct qualitative research on DXA barriers among general primary care population in order to facilitate health care delivery systems better equipped to diagnose and treat patients before their first fracture.

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A Survey of Women's Awareness of and Reasons for Lack of Postfracture Osteoporotic Care

Cited by 20 publications

References 49 publications

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs in the United States

Metasynthesis of Patient Attitudes Toward Bone Densitometry

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