Purpose
Despite the high prevalence, morbidity, and treatment costs for osteoporosis-related
fractures, studies have shown that patients infrequently receive the recommended treatment
for low bone density (LBD). This study investigated patient perceptions about evaluation,
management, and willingness to pursue osteoporosis treatment to further elucidate
potential barriers to LBD treatment.
Methods
A survey was prospectively administered to patients over 50 years old addressing patient
history of fragility fractures and osteoporosis evaluation and treatment, medication
administration preferences, and willingness to start a new medication to treat or
prevent future fragility fractures.
Results
Three hundred twenty-five patients completed surveys (63.1% women, 36.9% men; mean
age, 64.1 years). Patients reported the following: 50.8% had taken supplements or
medication for LBD. Patients who had never taken LBD prescription medications were
asked about their willingness to take these medications if physician-recommended.
The mean response on a 0 to 10 scale was 7.3 ± 3.2, which was not significantly different
between fracture or bone density subgroups. Several barriers to taking LBD medications
were identified: 85.7% said no medical provider had prescribed them; 14.0% stated
they already took too many medications; 10.4% were afraid of potential side effects;
4.3% had conflicting provider recommendations; and 1.8% cited financial concerns.
Conclusions
Patients held a favorable opinion on taking LBD medications when prescribed. Although
29.8% of patients had an abnormal dual-energy x-ray absorptiometry (DEXA) result,
85.7% of all patients reported that no medical provider had prescribed LBD medications.
A sizeable gap remains between current practice and optimal osteoporosis education
and management.
Clinical relevance
Despite the large reported and increasing prevalence of osteoporosis in patients with
upper extremity fragility fractures, the rate of treatment for LBD remains suboptimal.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Low prevalence of osteoporosis treatment in patients with recurrent major osteoporotic fracture.Arch Osteoporos. 2017; 12: 24
- The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine.J Bone Miner Res. 2014; 29: 2520-2526
- Trends in osteoporosis and low bone mass in older US adults, 2005–2006 through 2013–2014.Osteoporosis Int. 2017; 28: 1979-1988
- An overview and management of osteoporosis.Eur J Rheumatol. 2017; 4: 46-56
- Fracture risk following an osteoporotic fracture.Osteoporos Int. 2004; 15: 175-179
- Imminent fracture risk.Osteoporos Int. 2017; 28: 1765-1769
- Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women.JAMA. 2009; 301: 513-521
- Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025.J Bone Miner Res. 2007; 22: 465-475
- Randomised trial assessing the impact of framing of fracture risk and osteoporosis treatment benefits in patients undergoing bone densitometry.BMJ Open. 2017; 7e013703
- Osteoporosis medication use after hip fractures in patients between 2002 and 2011.J Bone Miner Res. 2014; 29: 1929-1937
- Medication adherence and fracture risk among patients on bisphosphonate therapy in a large United States health plan.Bone. 2012; 50: 870-875
- Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis.Mayo Clin Proc. 2007; 82: 1493-1501
- WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level. Summary Meeting Report.WHO, Geneva2007: 7-9
- Clinician's Guide to Prevention and Treatment of Osteoporosis.National Osteoporosis Foundation, Washington, DC2014
- The role of the orthopaedic surgeon in minimizing mortality and morbidity associated with fragility fractures.J Am Acad Orthop Surg. 2010; 18: 278-285
- Osteoporosis disease management: the role of the orthopaedic surgeon.J Bone Joint Surg Am. 2008; 90: 188-194
- A guide to improving the care of patients with fragility fractures.Geriatr Orthop Surg Rehabil. 2011; 2: 5-37
- A systematic review of persistence and compliance with bisphosphonates for osteoporosis.Osteoporosis Int. 2007; 18: 1023-1031
- Massachusetts State Health Assessment. Chap. 1: Population characteristics.Massachusetts Department of Public Health, BostonOctober 2017: 24-40
Article info
Publication history
Published online: March 22, 2019
Accepted:
January 25,
2019
Received:
December 7,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
