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Factors influencing the pharmacological management of osteoporosis after fragility fracture: results from the Ontario Osteoporosis Strategy’s fracture clinic screening program

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Abstract

Summary

Potential mediating factors in the pathway to initiation of osteoporosis treatment following a fragility fracture were evaluated. Patients’ perceived need for treatment, mediated by their perception of bone density test results, was central to treatment initiation. Interventions focusing on patients’ perceptions of need and test results may improve treatment rates.

Introduction

We tested a hypothesized pathway to osteoporosis (OP) pharmacotherapy initiation in fragility fracture patients. We hypothesized that bone mineral density (BMD) testing is strongly associated with treatment initiation and perception of BMD test results would inform patients’ perceived need for treatment, which would mediate the effect between BMD testing and treatment initiation.

Methods

A longitudinal cohort study followed patients, ≥50 years of age, screened for fragility fracture in 31 fracture clinics in Ontario, Canada who had no prior diagnosis of or treatment for OP. At screening, OP risk factors, baseline-patient perception of OP risk, OP knowledge, and perceived benefits of medication were reported by patients. Patients were followed up within 6 months of fracture to determine BMD testing and prescription of and adherence to first-line OP pharmacotherapy. Structural equation modeling tested the hypothesized pathway. Significance and magnitude of the coefficients and indicators of overall model fit were used to test our model.

Results

The direct path from BMD testing to OP treatment initiation was non-significant. The pathway to treatment initiation was mediated by patients’ perception of their need, which was influenced by their self-reported BMD results. Baseline fracture risk factors, knowledge of OP, and perceived benefits of treatment-predicted patient-perceived need for treatment at follow-up and initiation of OP treatment.

Conclusions

Patient perceptions were central factors in the path to initiation of OP pharmacotherapy. Interventions to facilitate accurate patient perceptions of BMD test results and OP risk status could prove helpful in improving OP treatment initiation.

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Acknowledgments

The authors thank the remaining members of the Fracture Clinic Screening Program Evaluation Team for their invaluable contributions to this research: R. Jain, S. Jaglal, G. Hawker, M. Mamdani, M. Gignac, S. M. Cadarette, M. Zwarenstein, F. Jiiwa, and V. Elliot-Gibson. The authors also thank Dagmar Gross for assistance with preparation of this manuscript. The authors gratefully acknowledge the support of Osteoporosis Canada, which implements the Ontario Osteoporosis Fracture Clinic Screening Program on behalf of the Ontario Ministry of Health and Long Term Care (MOHLTC). The authors also acknowledge the front-line Osteoporosis Screening Coordinators and Area Managers for their diligence with data collection and help with interpretation of the results. This study was supported by funding from the MOHLTC through the Ontario Osteoporosis Strategy. The views expressed in this article are those of the authors and may not reflect the opinions of the MOHLTC.

Conflicts of interest

Earl R. Bogoch has received speaker fees or honoraria from Merck Frosst Canada Ltd. and Merck Sharp & Dohme and has received research support as a principal investigator from Amgen Canada Inc., Novartis Canada Ltd., and Warner Chilcott. The other authors have no potential conflicts of interest to declare.

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Authors and Affiliations

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

    D. E. Beaton, S. Dyer, R. Sujic, J. E. M. Sale & E. R. Bogoch

  2. Institute for Work and Health, Toronto, ON, Canada

    D. E. Beaton

  3. Health Policy Management and Evaluation, Graduate Department of Rehabilitation Sciences, Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, ON, Canada

    D. E. Beaton

  4. Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Room S113–750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada

    D. Jiang

  5. Department of Family Medicine, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada

    M. Slater

  6. Department of Surgery, University of Toronto, 800-55 Queen Street East, Toronto, ON, M5C 1R6, Canada

    E. R. Bogoch

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  1. D. E. Beaton
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The Osteoporosis Fracture Clinic Screening Program Evaluation Team

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Correspondence to D. E. Beaton.

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Beaton, D.E., Dyer, S., Jiang, D. et al. Factors influencing the pharmacological management of osteoporosis after fragility fracture: results from the Ontario Osteoporosis Strategy’s fracture clinic screening program. Osteoporos Int 25, 289–296 (2014). https://doi.org/10.1007/s00198-013-2430-6

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  • DOI: https://doi.org/10.1007/s00198-013-2430-6

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