Predictors and Outcomes Associated With Adherence to Weekly Alendronate in US Military Veterans: Clinical Research Study

Malham, Sarah Bou; Bowe, Benjamin; Sen, Sumon K.; Zhang, Rong Mei; Sterkel, Barbara; Dunn, Julia P.

doi:10.1177/2150132719884300

Cited by 1 publication

(1 citation statement)

References 35 publications

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“…This finding contradicts adherence studies in osteoporosis and other health conditions that indicate smoking as a risk factor for low treatment uptake or nonadherence. (32,33,(38)(39)(40) However, these veterans may represent a population more likely to adhere owing to their completion of DXA and may see osteoporosis medication as an opportunity to improve bone health and counteract the effect of smoking. Alternatively, since smoking is more prevalent among veterans, it may not be as strong a proxy for health behavior as it is in the general population.…”

Section: Discussionmentioning

confidence: 99%

Engagement in Primary Prevention Program among Rural Veterans With Osteoporosis Risk

et al. 2022

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A primary osteoporosis prevention program using a virtual bone health team (BHT) was implemented to comanage the care of rural veterans in the Mountain West region of the United States. The BHT identified, screened, and treated rural veterans at risk for osteoporosis using telephone and United States Postal Service communications. Eligibility was determined by regular use of Veterans Health Administration primary care, age 50 or older, and evidence of fracture risk. This study was conducted to identify demographic and clinical factors associated with the acceptance of osteoporosis screening and the initiation of medication where indicated. A cross-sectional cohort design (N = 6985) was utilized with a generalized estimating equation and logit link function to account for facility-level clustering. Fully saturated and reduced models were fitted using backward selection. Less than a quarter of eligible veterans enrolled in BHT's program and completed screening. Factors associated with a lower likelihood of clinic enrollment included being of older age, unmarried, greater distance from VHA services, having a copayment, prior fracture, or history of rheumatoid arthritis. A majority of veterans with treatment indication started medication therapy (N = 453). In this subpopulation, Fisher's exact test showed a significant association between osteoporosis treatment uptake and a history of two or more falls in the prior year, selfreported parental history of fracture, current smoking, and weight-bearing exercise. The BHT was designed to reduce barriers to screening; however, for this population cost and travel continue to limit engagement. The remarkable rate of medication initiation notwithstanding, low enrollment reduces the impact of this primary prevention program, and findings pertaining to fracture, smoking, and exercise imply that health beliefs are an important contributing factor. Efforts to identify and address barriers to osteoporosis screening and treatment, such as clinical factors, social determinants of health, and health beliefs, may pave the way for effective implementation of population bone health care delivery systems.

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