Session Information
Date: Monday, November 9, 2015
Title: ACR/ARHP Combined Abstract Session: Epidemiology and Pubic Health
Session Type: ACR/ARHP Combined Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Osteoporotic fractures cause patient morbidity and increase risk for future fracture. Effective drug therapies for osteoporosis (OP) are available, yet only a minority of women receives osteoporosis pharmacotherapy (OP-Rx) post-fracture. Reasons for lack of post-fracture OP-Rx are not well understood. We undertook the first large scale survey of women with recent osteoporotic fractures to characterize their beliefs about OP and their physician interactions, and to understand the factors associated with lack of post-fracture OP-Rx.
Methods: A survey was mailed to 985 women, aged >55 years with an osteoporotic fracture in 2013-2014, who were enrollees of Group Health Cooperative, a large Northwest health plan. Receipt of OP-Rx in the 6 months post-fracture was determined from automated pharmacy data. The associations between factors of interest and non-receipt of post-fracture OP-Rx were assessed using age-adjusted modified Poisson regression with a robust sandwich estimator.
Results: 634 women returned the survey (73% response rate, excluding 119 ineligibles); mean age was 75 years (SD 11.1) and 77% were white. Primary fracture sites were distal forearm (31%), hip (27%), spine (14%), and humerus (18%). 84% of women did not receive OP-Rx within 6 months post fracture. Even among the 11% of women who were on OP-Rx prior to fracture, 40% did not continue therapy following the fracture. Only 20% of all respondents believed that OP-Rx reduces risk of fracture. Women who were not concerned about OP or future fractures, did not think OP caused their fracture, did not think OP-Rx was effective in reducing fractures, or did not believe a fracture put them at risk for future fracture were at increased risk for non-receipt of OP-Rx (Table). Similarly, women who did not discuss OP management or fracture prevention with their physicians, and whose primary source of information on OP was the media or family and friends rather than their medical providers were also at higher risk for not receiving OP-Rx.
Conclusion: The majority of women who suffered an OP fracture did not receive OP-Rx in the 6 months post-fracture. This study suggests that patient education about OP, the risk for future fracture after an initial fracture, and the potential benefits of therapy – through physician input or potentially other reliable sources – may help reverse the substantial under-treatment of women post-fracture.
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Table. Association between patient perspectives and interactions with medical providers on non-receipt of osteoporosis pharmacotherapy (OP-Rx) within 6 months of osteoporotic fracture |
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Relative Risk1 |
95% CI |
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Patient self-reported perspectives and beliefs on osteoporosis and fracture |
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Concerned about their future risk of fractures |
Not at all vs. very/somewhat |
1.13 |
1.05-1.21 |
|
Concerned about osteoporosis |
Not at all vs. very/somewhat |
1.21 |
1.14-1.28 |
|
Believe a fracture puts them at risk for future fractures |
No vs. yes |
1.17 |
1.09-1.25 |
|
Believe osteoporosis caused their fracture |
No vs. yes |
1.31 |
1.15-1.48 |
|
Believe OP-Rx reduces risk of fracture |
No vs. yes |
1.22 |
1.09-1.36 |
|
Believe harms of OP-Rx outweigh benefits |
Yes vs. no |
1.06 |
0.98-1.14 |
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Interactions with medical providers on osteoporosis and fractures |
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Primary source of information on osteoporosis |
Media vs. medical provider Family/friends vs. medical provider |
1.13 1.20 |
1.05-1.21 1.11-1.30 |
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PCP aware of fracture |
No vs. yes |
1.08 |
1.00-1.17 |
|
Told had osteoporosis by provider |
No vs. yes |
1.25 |
1.16-1.36 |
|
Provider recommendation to prevent fractures and/or manage osteoporosis |
OP-Rx Other (e.g. supplements, diet) No recommendation |
(ref) 1.89 1.85 |
1.61-2.21 1.57-2.19 |
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Contact with PCP post fracture |
No vs. yes |
1.03 |
0.92-1.15 |
|
Discussed preventing fractures |
No vs. yes |
1.13 |
1.04-1.24 |
|
Discussed managing osteoporosis |
No vs. yes |
1.38 |
1.23-1.54 |
|
Osteoporosis was among top 3 topics discussed at PCP visits |
No vs. yes |
1.34 |
1.21-1.49 |
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Time spent with PCP |
Not enough vs. enough |
0.92 |
0.78-1.08 |
Abbreviations: OP-Rx –osteoporosis pharmacotherapy; PCP – primary care provider
1 All risk estimates, except for age, are adjusted for age.
To cite this abstract in AMA style:
Boudreau D, Yu O, Balasubramanian A, Grafton J, Wirtz H, Grauer A, Crittenden DB, Scholes D. Awareness and Reasons for Lack of Post-Fracture Osteoporosis Therapy: A Survey of Post-Menopausal Women [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/awareness-and-reasons-for-lack-of-post-fracture-osteoporosis-therapy-a-survey-of-post-menopausal-women/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/awareness-and-reasons-for-lack-of-post-fracture-osteoporosis-therapy-a-survey-of-post-menopausal-women/