Barriers to Osteoporosis Identification and Treatment Among Primary Care Physicians and Orthopedic Surgeons

Simonelli, Christine; Killeen, Kathleen; Mehle, Susan; Swanson, Leah A.

doi:10.4065/77.4.334

Cited by 177 publications

(124 citation statements)

References 33 publications

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“…Individuals receiving long-term glucocorticoid treatment in our study population had a high burden of comorbidity (average of 6 major diseases), and high or low burdens of disease comorbidity may alter physicians' provision of glucocorticoid-induced osteoporosis-related care. Although our data showed that an increasing number of comorbid diseases was positively associated with osteoporosis care, other studies have indicated that individuals with high comorbidity burdens were less likely to be screened or treated for osteoporosis (32,33). Differences in the methods used to code comorbidity (e.g., using a disease count threshold instead of a continuous count) may account for this apparent discordance.…”

Section: Temporal Trends In Prevention Of Glucocorticoid-induced Ostecontrasting

confidence: 72%

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Curtis¹,

Westfall²,

Allison³

et al. 2005

Arthritis & Rheumatism

137

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Objective. To evaluate patient and physician factors associated with prevention of glucocorticoidinduced osteoporosis and to describe temporal trends in screening and prevention of glucocorticoid-induced osteoporosis.Methods. Using databases from a national managed care organization, enrollees who had been prescribed glucocorticoids (taken for at least 60 days) during an 18-month period were identified. Administrative data from January Conclusion. Despite significant temporal increases in the frequency of screening for and treatment of glucocorticoid-induced osteoporosis, absolute rates remain low, especially among men, African Americans, and patients of certain physician specialties.Glucocorticoids are prescribed widely in medical practice and are used by 0.5-2.5% of adults (1,2). Despite the acknowledged benefits of glucocorticoid treatment in controlling short-term inflammation, concerns about associated adverse events often limit its use. Among the most feared is glucocorticoid-induced osteoporosis. Rates of glucocorticoid-induced osteoporosisassociated fracture may approach 40% in selected populations (3,4), and this condition often results in

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Section: Temporal Trends In Prevention Of Glucocorticoid-induced Ostecontrasting

confidence: 72%

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Curtis¹,

Westfall²,

Allison³

et al. 2005

Arthritis & Rheumatism

137

View full text Add to dashboard Cite

show abstract

“…In addition, although all providers initially stated that both primary and specialty providers should be responsible for the prevention and management of GIOP in the questionnaire, focus group findings revealed differing ideas as to who should actually screen and follow up patients. In this regard, there is continuing controversy in the literature as to who should be responsible for the prevention and management of GIOP, with some authors supporting the view that primary care providers should take the lead in prevention (18,19). A majority of the focus group participants in the present study placed the responsibility for screening and management of GIOP on medicine subspecialists due to the limited time available to address multiple medical problems during a primary care clinic visit and the high likelihood that subspecialists will be treating patients needing long-term or high-dose steroids.…”

Section: Discussionmentioning

confidence: 99%

Barriers in the management of glucocorticoid‐induced osteoporosis

Guzman-Clark

Fang

Sehl

et al. 2007

Arthritis & Rheumatism

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Objective. To determine present practice for the management of glucocorticoid-induced osteoporosis (GIOP) in veterans; to characterize provider knowledge, beliefs, and practice behaviors regarding management of GIOP; and to identify potential barriers and interventions in the management of GIOP. Methods. To characterize current management of GIOP in an academic veterans administration medical center, we conducted a retrospective chart review of 100 patients who were prescribed a 90-day supply of prednisone. To assess clinicians' knowledge of GIOP clinical guidelines and perceptions of GIOP management, primary care clinicians and subspecialists completed a questionnaire and participated in focus groups. Results. Chart review revealed that only 32 of 100 patients receiving long-term glucocorticoid treatment underwent bone mineral density testing, and only 32 patients were prescribed the recommended calcium supplements. Of the 23 providers who completed the questionnaire and participated in the focus groups, 4 correctly identified both the dose and duration of glucocorticoid use at which GIOP prevention measures should be instituted. Common GIOP management barriers cited by participants were lack of knowledge, having limited time during the clinic visit to address all problems, patient nonadherence, and system problems. The most commonly mentioned potential interventions were the use of computerized clinical reminders and patient education. Conclusion. Clinicians frequently do not follow recommended guidelines for the management of GIOP. Improving the management of GIOP will likely require a fundamental redesigning of care processes for this disorder in order to overcome provider, patient-related, and system barriers.

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“…After being discharged from rehabilitation and living in the community, bone health evaluation may involve the ongoing care by physiatrists and/or family physicians. Family physicians' opinions of bone health in the general population has been discussed elsewhere, [11][12][13] however, to our knowledge there are no other published surveys of physiatrists' practice patterns or clinical practice guidelines for bone health specific to SCI. Therefore, understanding physiatrists' opi-nions and practice patterns could provide insight and a foundation for the development of standards for bone health management.…”

Section: Introductionmentioning

confidence: 99%

Physiatrists' opinions and practice patterns for bone health after SCI

2008

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Study design: Self-report survey Objective: To ascertain physiatrists' opinions and current practice patterns for bone health management after spinal cord injury (SCI). Participants: Physiatrists who work in teaching rehabilitation centers in Canada. Methods: A 4-page 17-question survey (available in French and English) was sent to working physiatrists in all major Canadian SCI rehabilitation centers. Results: We had an 85% response rate (22 responses). Physiatrists reported that they should be managing bone health issues after SCI in conjunction with family physicians, and most respondents assess and treat for bone health after SCI. However, just over one-third of the physiatrists reported that the current treatment options are not effective for low bone mass; there was more support for pharmacological treatments than there was for rehabilitation modalities. Conclusion: Bone health after SCI is an important health concern that is being managed by physiatrists; however, more discussion and research is needed to ascertain the effectiveness of assessment and treatment options for low bone mass. Spinal Cord IntroductionBone health after a spinal cord injury (SCI) is an important issue that needs to be addressed because of an increased risk for fragility fractures 1-5 and the majority of these fractures occur during transfers or other activities that involve minimal or no trauma. 1 Contributing to the increased risk for fragility fracture is the loss of bone mineral density (BMD) in the lower extremity that was initially thought to stabilize around 1 year after injury 6 but below that of ablebodied peers. More recent literature supports a continual loss of bone mass with time since injury suggesting that bone mineral loss continues 7 and contributes to the increased risk of fractures. In the general population, people who sustain a low-impact trauma fracture (falling from a standing height or less) have an increased risk for subsequent fracture, thus practice guidelines emphasize that these fragility fractures should prompt a workup to determine possible causes and appropriate management. 8 For people with SCI, previous literature suggests that the mean incidence of lower limb fracture is approximately 2% per year. 9 Yet despite these data there has been little published studies to highlight physiatrist practice patterns for bone health specifically for people with SCI.Prevention and treatment of osteoporosis following SCI has been investigated as early as a few days after the initial injury. 10 However, in practice, bone health interventions are generally initiated in the in-patient rehabilitation setting where physiatrists, specialists in rehabilitation medicine, are most often involved. In Canada, as advocated from best practice guidelines, people with SCI are treated in specialized rehabilitation centers that are teaching hospitals. After being discharged from rehabilitation and living in the community, bone health evaluation may involve the ongoing care by physiatrists and/or family physicians. Family physici...

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Barriers to Osteoporosis Identification and Treatment Among Primary Care Physicians and Orthopedic Surgeons

Cited by 177 publications

References 33 publications

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Barriers in the management of glucocorticoid‐induced osteoporosis

Physiatrists' opinions and practice patterns for bone health after SCI

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