Osteoporosis knowledge among individuals with recent fragility fracture

A 10-Year Experience of an Integrated Geriatric Hip Fracture Treatment Protocol: Outcomes at a Minimum 2-Year Follow-Up

Introduction

Increasing incidence of fragility fractures has spurred development of protocols, largely focused on peri-operative care, with numerous proven benefits. The purpose of this investigation was to evaluate outcomes of our hip fracture treatment program regarding successful protocol implementation, compliance, effect on subsequent fracture rates, and mortality during the first decade of adoption.

Methods

A retrospective review identified patients >65 years old with fragility hip fractures between 2010 and 2022. The HiROC (+) cohort consisted of patients who received a "High-Risk Osteoporosis Clinic" (HiROC) referral for bone health evaluation and bisphosphonate initiation as indicated. Additional fracture rates and mortality at 3 years were calculated. Protocol implementation and compliance over the first 10 years was analyzed in the four identified cohorts.

Results

A total of 1671 fragility hip fractures were identified, with 386 excluded due to insufficient follow-up, with an average age of 81.6 years and a median follow-up of 36.4 months. Of the 1280 included cases, 56% (n = 717) had a HiROC referral placed. HiROC(+) groups had lower subsequent fracture rates at two years, compared to those without referral (28% vs 13%, P < 0.0001) and those completing more steps of the protocol had lower subsequent fracture rates (28% vs 15% vs 13% vs 5%, P < 0.0001). No statistically significant difference was observed between the cohorts for anatomic site of subsequent fractures.

Discussion

Greater than half of all eligible patients were successfully captured by the protocol. Patients completing more steps of the protocol had lower subsequent fracture rates. Captured patients demonstrated reduced mortality rates when compared to current literature.

Conclusion

Successful implementation of this geriatric hip fracture protocol was associated with reduced additional fractures and mortality rates. Identifying steps of process failures in the protocol can provide opportunities for increased compliance and reduction in future fracture occurrences.

How much do patients know about osteoporosis? A survey among patients referred to the dual-energy X-ray absorptiometry exam

BACKGROUND

Inadequate osteoporosis education can make patients ill-informed concerning preventive and therapeutic interventions and creates misconceptions and unnecessary concerns about the disease.

AIM

Our study aimed to assess whether patients referred to the DXA exam by their general practitioner are informed about risk factors for osteoporosis, comparing patients who received a diagnosis of osteoporosis before the exam with those without this diagnosis.

METHODS

An observational single-center study was performed among patients who were referred to the DXA exam at the Osteoporosis Service of Marche Nord Hospital (Fano, Italy) between April and July 2019. Socio-demographic and clinical characteristics, awareness of suffering from osteoporosis, femoral and lumbar spine T-score and bone mineral density, risk of fracture and the I-FOOQ score were assessed.

RESULTS

A pilot study was carried out to validate the questionnaire in the Italian language (alpha-Cronbach 0.75). After that, a sample of 128 patients was enrolled (response rate 93.3%). Mean age was 66 ± 10.6 years, 95.6% were women. Overall, I-FOOQ mean score was 12 ± 3.5. Age, educational level, menopausal age, body mass index, femoral T-score were not associated with a better knowledge (p > 0.05). A comparison between who know to suffer from osteoporosis and others found no differences (12.2 ± 3.4 and 12 ± 3.5, respectively, p = 0.772). Effect of walking, recommended calcium intake, and familiar predisposition are the less known topics.

CONCLUSION

Patients who undergo the DXA exam are poorly informed about risk factors for osteoporosis, independently of age, education, bone mineral density and risk of fracture. Knowing to suffer from osteoporosis does not increase the likelihood to be informed. It is mandatory to improve the education that is provided to the patients, as there are effective non-pharmacological interventions to prevent and treat osteoporosis.

A Rehabilitation-Based Multidisciplinary Care Model Reduces Hip Fracture Mortality in Older Adults

Purpose

In older adults, the one-year mortality rate after experiencing a hip fracture ranges between 8% and 36%. The purpose of this study was to look at the efficacy of rehabilitation-based multidisciplinary care for older individuals who had hip fractures.

Patients and Methods

The study included 185 people (aged 65 and over) with a history of hip fracture surgery between February 2014 and March 2017. A survey was conducted one month and six months following the operation to assess the recovery of 93 individuals who were part of a rehabilitation-based multidisciplinary care program and 92 patients who were getting standard therapy with surgery and unsupervised physical therapy.

Results

Physical activity, gait, balance evaluation, and depression scale ratings all had statistical significance (P < 0.05) after participants received rehabilitation-based care services from multidisciplinary medical professionals. Furthermore, the refracture and one-year mortality rates in this rehabilitation-based multidisciplinary care model were lower than in the groups getting standard therapy.

Conclusion

The research indicates the efficacy of a multidisciplinary rehabilitation strategy provided by a collaborative medical team to older individuals with hip fractures.

Covid-19 given opportunity to use ultrasound in the plaster room to continue secondary fracture prevention care: A retrospective Fracture Liaison Service study

INTRODUCTION

Fracture Liaison Service (FLS) managed secondary fracture prevention services have been hampered during the COVID-19 pandemic. A challenging opportunity is to use pulse-echo ultrasound (P-EU) in the plaster room. The study had two objectives: can P-EU help our decision to justly avoid DXA/VFA scans in plaster treated women (50-70 years) after fracture and whether its use can encourage or nudge all plaster treated patients (>50 years) who need DXA/VFA scans.

PATIENTS AND METHODS

1307 patients (cohort: pre-COVID-19) and 1056 patients (cohort: peri-COVID-19), each of them ≥ 50 years after recent fracture, were studied. Only in women aged 50-70 years, we used a P-EU decision threshold (DI) >= 0.896 g/cm² to rule out further analysis by means of DXA/VFA. All other plaster patients received P-EU as part of patient information. Peri-Covid-19, all performed DXA/VFA scans were counted until three months post-study closure. By then each patient still waiting for a DXA/VFA had received a scan.

RESULTS

Peri-COVID-19, 69 out of 191 plaster-treated women aged 50-70 years were ruled out (36%), for plaster and not in-plaster treated women aged 50-70 years, it was 27%. Comparing all peri-to pre-COVID-19 plaster-treated women and men, a significant P-EU nudging effect was found (difference in proportions: 8.8%) P = .001.

CONCLUSION

The combination of patient information and P-EU in the plaster room is effective to reduce DXA/VFA scans and allow extra patients to undergo DXA/VFA. After all, more than a quarter of 50-70 years old women in plaster did not need to be scanned.

Knowledge and Beliefs on Osteoporosis among African Postmenopausal Women in a Kenyan Semi-Rural County of Kiambu

BACKGROUND

Assessing people's knowledge and beliefs about osteoporosis is fundamental to the formulation of preventive strategies for this condition. To our knowledge, no randomized community survey has been conducted using Facts on Osteoporosis Quiz (FOOQ) and Osteoporosis Health Belief Scale (OHBS) exclusively in the postmenopausal women in Kenya. This study aimed to assess postmenopausal women&apos;s knowledge and beliefs concerning osteoporosis in semirural Kiambu County, Kenya.

METHODS

A cross-sectional study involving face-to-face interviews with 254 African postmenopausal women was conducted between October 2017 and February 2018. The questionnaire explored the socio-demographic characteristics; FOOQ was used to evaluate the knowledge these women had about osteoporosis, while OHBS was used to assess their beliefs.

RESULTS

The mean age of the participants was 64.6±10.7 years. About 26.4% (67/254) of the participants had no formal education, while 3.1% (8/254) were in formal employment. About 54.3% (138/254) of the women were married, and 51.2% (130/254) were in the lowest and lower wealth quintile. FOOQ had a mean score of 8.6 (standard deviation±1.8; range, 0-17). OHBS revealed a low level of perceived susceptibility to osteoporosis. Perceived benefits of exercising and calcium intake as well as perceived seriousness of osteoporosis as a disease were at moderate levels. The level of health motivation was also moderate.

CONCLUSIONS

The women in this study demonstrated limited knowledge about osteoporosis. The low susceptibility score makes the prevention and treatment of osteoporosis in this population challenging. We recommend public health education for all postmenopausal women in this setting.

Characterization of fracture liaison service non-responders after invitation by home visits and questionnaires

This study aimed to gain insight in specific characteristics and beliefs of FLS non-responders.

INTRODUCTION

The proportion of non-responding fracture liaison service (FLS) invitees is high but characteristics of FLS non-responders are unknown.

METHODS

We contacted FLS non-responders by telephone to consent with home visit (HV) and to fill in a questionnaire or, if HV was refused, to receive a questionnaire by post (Q), to gain insight in beliefs on fracture cause and subsequent fracture risk.

RESULTS

Out of 716 FLS invitees, 510 attended, nine declined, and 197 did not respond. Of these non-responders, 181 patients were consecutively traced and phoned until 50 consented with HV. Forty-two declined HV but consented with Q. Excluded were eight Q-consenters in whom no choice was offered (either HV or Q) and 81 patients who declined any proposition (non-HV|Q). 62% HV and Q could recall the FLS invitation letter. The fracture cause was differently believed between HV and Q; the fall (96% versus 79%, p = .02), bad physical condition (36% versus 2%, p = .0001), dizziness or imbalance (24% versus Q 7%, p = .03), osteoporosis (16% versus 2%, p = .02), and increased fracture risk (26% versus 17%, NS). Age ≥ 70, woman, and major fracture were significantly associated with HV consent compared to Q (OR 2.7, 2.5, and 2.4, respectively) and HV compared to non-HV|Q (OR 16.8, 5.3, and 6.1).

CONCLUSION

FLS non-responders consider fracture risk as low. Note, 50 patients (about 25%) consented with a home visit after one telephone call, mainly older women with a major fracture. This non-responder subgroup with high subsequent fracture risk is therefore approachable for secondary fracture prevention.

The use of pulse-echo ultrasound in women with a recent non-vertebral fracture to identify those without osteoporosis and/or a subclinical vertebral fracture: a pilot study

A pilot study on the use of P-EU to identify patients without osteoporosis and/or a subclinical vertebral fracture after a recently sustained non-vertebral fracture (NVF).

INTRODUCTION

Screening with portable devices at emergency departments or plaster rooms could be of interest to limit referrals for dual X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). We calculated the number of negative tests for osteoporosis and/or subclinical vertebral fractures (VFs) using pulse-echo ultrasonometry (P-UE) at different thresholds.

PATIENTS AND METHODS

In this cross-sectional study, 209 consecutive women of 50-70 years with a recent non-vertebral fracture (NVF) were studied at the Fracture Liaison Service (FLS) of one hospital. All women received DXA/VFA and P-EU (Bindex®) assessments. Various P-EU thresholds (based on the density index (DI, g/cm²)) were analyzed to calculate the best balance between true negative (indeed no osteoporosis and/or subclinical VF) and false negative tests (osteoporosis and/or subclinical VF according to DXA/VFA).

RESULTS

Eighty-three women had osteoporosis (40%) and 17 women at least one VF (8%). Applying the manufacturer's recommended P-EU threshold (DI 0.844 g/cm²) being their proposed cut-off for not having hip osteoporosis resulted in 77 negative tests (37%, 31% true negative and 6% false negative tests). A DI of 0.896 g/cm² resulted in 40 negative tests (19.3%) (38 true negative (18.3%) and 2 false negative tests (1.0%)).

CONCLUSION

The application of P-EU enables the identification of a substantial proportion of women with recent non-vertebral fractures at the FLS who would not need a DXA/VFA referral because they had no osteoporosis and/or subclinical vertebral fractures. The most conservative P-EU threshold resulted in 18.3% true negative tests verified by DXA/VFA against 1% false negative test results.

Therapist's practice patterns for subsequent fall/osteoporotic fracture prevention for patients with a distal radius fracture

STUDY DESIGN

Cross-sectional survey.

INTRODUCTION

Multifactorial risk factor screening and treatment is needed for subsequent falls/osteoporotic fractures prevention (SFOFP), given the elevated risk among patients with distal radius fracture (DRF).

PURPOSE OF THE STUDY

The primary objective was to describe hand therapists' knowledge and clinical practice patterns for assessment, treatment, referral, and education with respect to SFOFP for patients with DRF older than 45 years. Secondary objective was to explore therapist's preferences in content and delivery of knowledge translation tools that would support implementation of SFOFP.

METHODS

A cross-sectional multinational (Canada, the United States, and India) survey was conducted among 272 therapists from August to October 2014. Completed surveys were analyzed descriptively.

RESULTS

Surveys were completed by 157 therapists. Most respondents were from the United States (59%), certified hand therapists (54%), and females (87%). Although 65%-90% believed that they had knowledge about SFOFP assessment, treatment, and referral options, 55% did not include it in their routine practice for patients with DRF. Most assessed medication history (82%) and never used a Fracture Risk Assessment Tool (90%) or lower extremity muscle strength testing (54%) to identify those at risk of secondary fractures. With respect to treatment, approximately 33% always used upper extremity muscle strengthening exercises. Most reported rarely (sometimes to never) using balance (79%), lower extremity muscle strengthening (85%), bone strengthening (54%), or community-based physical activity (72%) programs. Similarly, when surveyed about patient education, therapists rarely (sometimes to never) advised patients about web-based resources (94%), regular vision testing (92%), diet for good bone health (87%), bone density evaluation (86%), footwear correction (73%), and hazard identification (67%). Most hand therapists were interested to receive more information on SFOFP for patients with DRF. Nearly one-half preferred to have Web sites for patients, and two-fifth were in favor of pamphlets for patients.

CONCLUSION

Current practice patterns reveal care gaps and limited implementation with respect to SFOFP for patients with DRF. Future research should focus on web-based educational/knowledge translation strategies to promote implementation of multifactorial fall risk screening and hand therapist's engagement in SFOFP for patients with DRF.

Construction and validation of the Lebanese Osteoporosis Knowledge Scale among a representative sample of Lebanese women

Our study aimed at constructing and validating the Lebanese Osteoporosis Knowledge Scale adapted for use among Lebanese women and to assess factors associated with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures. This scale showed adequate psychometric properties; higher knowledge scores were reached in women who already heard about the disease and had a formal education. As a result, the LOKS-19 can be used to measure knowledge of osteoporosis and help assess osteoporosis-related interventions.

INTRODUCTION

The primary objective of this study was to describe the construction of the Lebanese Osteoporosis Knowledge Scale (LOKS) and assess its psychometric properties in a representative sample of Lebanese women aged 40 years and above. Secondary objectives were to explore factors associated with this knowledge score.

METHODS

A cross-sectional study carried out between March and June 2018, enrolled 560 women over the age of 40 years living in the community. This proportionate sample was randomly selected from all Lebanese governorates to cover the entire Lebanese area. A survey was developed and adapted to the Lebanese population based on preexisting scales. Personal interviews were conducted to collect data.

RESULTS

The items of the LOKS were distributed across seven factors with an Eigenvalue over 1 solution, outlining an overall value of 55.89% of the variance. A high Cronbach's alpha was found for the full scale (0.725). Individuals having a university level of education (beta = 1.62; compared to illiteracy), having heard of osteoporosis (beta = 2.62), taking supplements of calcium and vitamin D compared to none (beta = 0.77), and having had Crohn's disease (beta = 1.71) had significantly higher knowledge scores of osteoporosis; oppositely, having diabetes (beta = - 1.17), currently taking chemotherapy (beta = - 2.25), and ever having had a fracture (beta = - 0.74) were significantly correlated with lower awareness of osteoporosis.

CONCLUSIONS

Our findings suggest that the LOKS-19 can be used to measure knowledge of osteoporosis and help assess osteoporosis-related interventions. A better knowledge seems to be associated with more preventive measures and less risk of fracture.

Knowledge, beliefs, and concerns about bone health from a systematic review and metasynthesis of qualitative studies

Background

Patients with low bone density or osteoporosis need information for effective prevention or disease management, respectively. However, patients may not be getting enough information from their primary care providers or other sources. Inadequate disease information leaves patients ill-informed and creates misconceptions and unnecessary concerns about the disease.

Objective

We systematically reviewed and synthesized the available literature to determine patient knowledge, beliefs, and concerns about osteoporosis and identify potential gaps in knowledge.

Methods

A systematic search was conducted for full-text qualitative studies addressing understanding, literacy, and/or perceptions about osteoporosis and its management, using Medline, EMBASE, Web of Science, Cochrane Library, CINAHL, ERIC, PsychINFO, Psyc Behav Sci Collec, and PubMed, from inception through September 2016. Studies were selected by two reviewers, assessed for quality, and themes extracted using the Joanna Briggs Institute data extraction tool. Thematic analysis was used to identify themes and subthemes.

Results

Twenty-five studies with a total of 757 participants (including 105 men) were selected for analysis out of 1031 unique citations. Selected studies were from Australia, Canada, Denmark, Norway, the United Kingdom, and the United States. Four main themes emerged: inadequate knowledge, beliefs and misconceptions, concerns about osteoporosis, and lack of information from health care providers. Participants had inadequate knowledge about osteoporosis and were particularly uninformed about risk factors, causes, treatment, and prevention. Areas of concern for participants included diagnosis, medication side effects, and inadequate information from primary care providers.

Conclusion

Although there was general awareness of osteoporosis, many misconceptions and concerns were evident. Education on bone health needs to reinforce areas of knowledge and address deficits, misconceptions, and concerns.

Low rate of densitometric diagnosis and treatment in patients with severe osteoporosis in Colombia

Our study describes the clinical characteristics of patients with fragility fractures. It also shows there is a low knowledge about osteoporosis and its relation to fractures, in addition to the very poor adherence to medical advice and treatment.

INTRODUCTION

Osteoporosis is a systemic skeletal disease associated with an increased risk of fragility fractures and is a public health problem worldwide due to population aging. Early osteoporosis diagnosis and treatment is very important for reducing the incidence of fragility fractures and the resulting complications. Our study describes the clinical characteristics of patients with fragility fractures and their risk factors, evaluates the level of knowledge that patients have about osteoporosis, and follows-up on each case to establish if, after the fracture, a densitometric diagnosis was made and the patient received specific treatment in his outpatient follow-up through his health insurance plan.

METHODS

A descriptive cross-sectional study was carried out in a university hospital in Bogotá, Colombia. The data was collected by means of a questionnaire, administered to all patients admitted by the orthopedic emergency department with a diagnosis of fragility fracture. After discharge, a telephone follow-up was done every 3 months for 1 year, and patients were asked if they had already had the dual X-ray absorptiometry (DXA) scan and if they had begun osteoporosis treatment.

RESULTS

A total of 111 patients with an average age of 74.4 years (± 11.3 years), of which 84 (75.6%) were women, all consulted for osteoporotic fracture at the orthopedic emergency department of the hospital. Hip fracture was the most frequent (51.4%), followed by vertebral (23.4%), wrist (22.5%), and humerus (4.5%) fracture. A total of 49.5% (n = 55) of the patients did not know what osteoporosis is; 58.6% (n = 65) did not know that fracture is the main complication of this disease, and 62.2% (n = 69) did not associate fractures with osteoporosis. All patients were educated about osteoporosis and the importance of diagnosing and treating it. Patients were given a medical order to have a DXA scan upon discharge; however, only 24.3% (n = 27) had the DXA scan in the first year of the fracture. A total of 33.3% (n = 37) received calcium plus vitamin D, and only 9.9% (n = 11) received osteoporosis treatment (7 bisphosphonate patients and 4 denosumab). No patient received osteoformative therapy.

CONCLUSIONS

Our study shows that Colombian patients have little knowledge about osteoporosis and its relationship with fragility fractures. It also shows that densitometries are not done and, what is worse, patients with a diagnosis of fracture have limited access to treatment after discharge.

Challenges and opportunities to improve fracture liaison service attendance: fracture registration and patient characteristics and motivations

This questionnaire-based study evaluated the reasons for attendance or non-attendance at the fracture liaison service in patients with a recent fracture. Frailty, male sex, living alone, and low education were associated with non-attendance, and the information perceived by the patient was associated with attendance.

INTRODUCTION

The purpose of this study was to evaluate hospital registration- and patient-related factors associated with attendance or non-attendance to the Fracture Liaison Service (FLS).

METHODS

Out of 1728 consecutive patients registered with a recent fracture at hospital entry, and after exclusion of 440 patients because of death, residence in a nursing home, already on osteoporosis treatment, or recent DXA, 1288 received an FLS invitation. We evaluated the hospital registration of fractures at entry and exit of the hospital. A questionnaire was sent to all invited patients to evaluate factors related to non-attendance (including age, gender, frailty, living alone, income, education, extrinsic motivations (impact of perceived information) and intrinsic motivations (patient's own perceived views and opinions) and to attendance (personal impact of clinical professionals' advice).

RESULTS

There were 278 more hospital exit codes than entry codes. Of the 1288 invited patients, 745 returned analyzable questionnaires (537 attenders and 208 non-attenders). Non-attendance was associated with male gender (OR: 2.08, 95% CI: 1.35, 3.21), frailty (OR: 1.62, CI: 1.08, 2.45), living alone (OR:2.05, CI: 1.48, 2.85), low education (OR: 1.82, CI: 1.27, 2.63), not interested in bone strength (OR: 1.85, CI: 1.33, 2.63), and being unaware of increased subsequent fracture risk (OR: 1.75, CI: 1.08, 2.86). Information perceived by the patient was significantly associated with attendance (OR: 3.32, CI: 1.75, 6.27).

CONCLUSION

Fracture entry registration inaccuracies, male gender, frailty, living alone, having low general education, or low interest in bone health and subsequent fracture risk were independently associated with FLS non-attendance. Adequately perceived advice (to have a bone densitometry and attend the FLS) was strongly associated with FLS attendance.

Osteoporosis awareness and health beliefs among Lebanese women aged 40 years and above

Our study investigated the characteristics of Lebanese women population groups with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures in order to identify categories that should be targeted in future campaigns and educational programs. Higher knowledge scores were reached in women who already heard about the disease and had a formal education. As a result, osteoporosis awareness campaigns and educational programs are mostly needed in populations with lower educational levels.

INTRODUCTION

Our study investigated the characteristics of Lebanese women population groups with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures.

METHODS

A cross-sectional study, conducted between March and June 2018, enrolled 560 community dwelling women aged 40 years and above. A questionnaire was used to collect data. A proportionate random sample from all Lebanese Mohafazat was used. Data collection was performed through personal interviews. The median was used as a cutoff point for both the Knowledge and Health Belief scales.

RESULTS

The study results showed that 47.3% of participants had a poor knowledge score. Women who received no education, compared to a higher education and have not previously heard about the disease, had lower knowledge scores. In addition, women not taking calcium and vitamin D supplements and not exercising or exercising less than 20 min per day compared to those having these characteristics had lower osteoporosis knowledge levels. A lower knowledge score was associated with less recognized benefits of adequate calcium intake and regular physical activity, more perceived barriers towards their practice, and a less important health motivation. A lower level of education correlated to the same results.

CONCLUSION

Lower knowledge scores were reached in women who have never heard of osteoporosis and had a lower level of education. As a result, osteoporosis awareness campaigns and educational programs need to target population categories with lower educational levels.

Perception of peri-menopausal and postmenopausal Lebanese women on osteoporosis: A cross-sectional study

INTRODUCTION

Osteoporosis is a generalized skeletal disorder characterized by decreased bone mineral density and microarchitectural deterioration, resulting in increased susceptibility to fractures. The prevalence of osteoporosis in Lebanon, defined as T-score <-2.5 at the total hip using NHANES gender-specific database was estimated to be 31% among postmenopausal women.

PURPOSE

To assess the general perception of osteoporosis among women in Lebanon as well as their general knowledge of its lifestyle, risk factors, diagnostic, preventive and therapeutic measures.

METHODS

A cross-sectional study was conducted in Lebanon between January and December 2017. Women above the age of 50 were invited to participate. A standardized questionnaire regarding the perception of personal risk of osteoporosis and fractures was used. Risk factors for osteoporosis, previous fractures or falls, family history of fracture, smoking, alcohol consumption, and secondary causes of osteoporosis were evaluated. Data were recorded on excel and analyzed on SPSS using variety of descriptive analysis, ANOVA tests, and others. P value <0.05 was considered to be statistically significant.

RESULTS

From 396 interviewed women, 85% were in menopause and were more likely to be diagnosed with osteoporosis. 45% knew the true definition of osteoporosis and their most frequent source of information was doctors. Around 60% had heard of BMD screening but only 54.5% of those women actually did it.

CONCLUSION

This study reveals that osteoporosis knowledge and perception is low among the Lebanese woman aged 50 years and older.

Knowledge of risk factors and prevention of osteoporosis: the Israeli women's health at midlife study

Wide disparities in knowledge of risk factors and prevention of osteoporosis were demonstrated among midlife Israeli minority women (Arabs and immigrants from the former USSR) compared to Jewish long-time residents. Women who believed osteoporosis to be a serious disease and those who felt susceptible to it reported better knowledge.

PURPOSE

The main goals of this study were to assess knowledge of risk factors and preventive measures for osteoporosis in middle-aged women and to evaluate the relationship of knowledge to personal risk factors and personal perceptions about osteoporosis.

METHODS

Face-to-face interviews with women aged 45-64 years were conducted during 2004-2006 within three population groups: long-term Jewish residents (LTJRs), immigrants from the former Soviet Union, and Arab women. The survey instrument included five knowledge statements related to the risk after menopause, the risk of smoking, family history of fractures, decreased risk by physical activity, and by use of medications.

RESULTS

The findings indicated wide disparities in knowledge about risk factors and preventive behavior of osteoporosis between the two minority groups (immigrants from the former Soviet Union and Arab women) and the majority group of midlife Israeli women. Knowledge of osteoporosis was related to perceived severity of the disease and partly to perceived susceptibility to osteoporosis. Past diagnosis of osteoporosis, current or past smoking status, and BMI were unrelated to knowledge in multivariate analyses.

CONCLUSIONS

There is a need to improve knowledge of osteoporosis especially among less educated and minority women. Subjective perception of risk was more strongly related to knowledge than actual risk factors and should be targeted in public campaigns. The efforts should be aimed at strengthening women's perception of their own susceptibility to osteoporosis and of the severity of this disease.

Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records

OBJECTIVE

This study aimed to estimate the association of frailty with incidence and mortality of fractures at different sites in people aged over 80 years.

DESIGN

Cohort study.

SETTING

UK family practices from 2001 to 2014.

PARTICIPANTS

265 195 registered participants aged 80 years and older.

MEASUREMENTS

Frailty status classified into 'fit', 'mild', 'moderate' and 'severe' frailty. Fractures, classified into non-fragility and fragility, including fractures of femur, pelvis, shoulder and upper arm, and forearm/wrist. Incidence of fracture, and mortality within 90 days and 1 year, were estimated.

RESULTS

There were 28 643 fractures including: non-fragility fractures, 9101; femur, 12 501; pelvis, 2172; shoulder and upper arm, 4965; and forearm/wrist, 6315. The incidence of each fracture type was higher in women and increased with frailty category (femur, severe frailty compared with 'fit', incidence rate ratio (IRR) 2.4, 95% CI 2.3 to 2.6). Fractures of the femur (95-99 years compared with 80-84 years, IRR 2.7, 95% CI 2.6 to 2.9) and pelvis (IRR 2.9, 95% CI 2.5 to 3.3) were strongly associated with age but non-fragility and forearm fractures were not. Mortality within 90 days was greatest for femur fracture (adjusted HR, compared with forearm fracture 4.3, 95% CI 3.7 to 5.1). Mortality was higher in men and increased with age (HR 5.3, 95% CI 4.3 to 6.5 in those over 100 years compared with 80-84 years) but was less strongly associated with frailty category. Similar associations with fractures were seen at 1-year mortality.

CONCLUSIONS

The incidence of fractures at all sites was higher in women and strongly associated with advancing frailty status, while the risk of mortality after a fracture was greater in men and was associated with age rather than frailty category.

Comparison of CAROC and FRAX in Fragility Fracture Patients: Agreement, Clinical Utility, and Implications for Clinical Practice

Objective.

To examine the level of agreement between 2 fracture risk assessment tools [Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and Canadian Fracture Risk Assessment (FRAX)] when applied within the context of the Canadian guidelines, in a population of fragility fracture patients.

Methods.

The sample consisted of 135 treatment-naive fragility fracture patients aged 50+ years and screened as part of an osteoporosis (OP) program at an urban hospital. Ten-year probabilities of future major osteoporotic fractures were calculated using the FRAX and CAROC. We also integrated additional qualifiers from the 2010 Canadian guidelines that place hip, spine, and multiple fractures at high risk regardless. A quadratic weighted κ (Kw) and 95% CI were calculated to estimate the chance corrected agreement between the risk assessment tools. Logistic regression was used to evaluate the factors associated with concordance.

Results.

Among patients with fragility fractures, the agreement between CAROC and FRAX was Kw = 0.64 (95% CI 0.58–0.71), with 45 of 135 cases in the cells reflecting disagreement. Younger persons and males were more likely to be found in discordant cells.

Conclusion.

The level of agreement between 2 commonly used fracture risk assessment tools was not as high in the patients with fragility fractures as it was in general community-based samples. Our results suggest discordance is found in less-typical patients with OP who need more consistency in messaging and direction. Users of these fracture risk tools should be aware of the potential for discordance and note differences in risk classifications that may affect treatment decisions.

Knowledge, attitude, and practice of osteoporosis among Saudis: a community-based study

BACKGROUND

Osteoporosis is a global public health problem currently affecting millions of people worldwide, and Saudi Arabia is not an exception. Awareness and perceptions of susceptibility and belief in the seriousness of a disease can help in its prevention and control. We aimed to assess knowledge, attitude, and practices for osteoporosis among Saudi general population and to identify its determining factors.

METHODS

A cross-sectional survey of people aged 18 years or older representing every region in the Kingdom of Saudi Arabia was carried out. A total of 2174 self-administered questionnaires were distributed to identify the levels of knowledge, attitude, and practice.

RESULTS

Responses were obtained from 1830 individuals (42% female and 58% male). The majority of the study sample had heard about osteoporosis (78%). There were significant associations between the level of awareness and the following sociodemographics of the participants: age, sex, education, occupation, income, and residence (P<0.01). Regular practice of the main preventive behaviors was correlated with an increase in the level of awareness.

CONCLUSION AND RECOMMENDATIONS

The majority of the study cohort had heard about osteoporosis. Female respondents were more knowledgeable. Age was negatively correlated with the level of awareness. Awareness levels and the main sociodemographic determinants were significantly associated. The study recommended that health authorities and physicians should have better involvement in patient education efforts to improve and maintain the information provided on osteoporosis.

Concern and risk perception of osteoporosis and fracture among post-menopausal Australian women: results from the Global Longitudinal Study of Osteoporosis in Women (GLOW) cohort

PURPOSE

The purpose of this study is to identify factors associated with concern and perception of risks of osteoporosis and osteoporotic fractures and determine whether bone mineral density (BMD) testing influenced concern and risk perception.

METHODS

Study subjects (n = 1,082, age 55-94 years) were female Australian participants of the Global Longitudinal Study of Osteoporosis in Women (GLOW). Self-administered questionnaires were sent annually from 2007 to 2010. Study outcomes included 'concern about osteoporosis', 'perception of getting osteoporosis' and 'perception of fracture risk' compared to similar aged women. The closest post-BMD testing or baseline questionnaires were used for women with and without BMD testing, respectively. Multinomial logistic regression was used for the analysis.

RESULTS

BMD testing, prior fracture after age 45, younger age and lower self-reported general health were significantly associated with being 'very' or 'somewhat concerned' about osteoporosis and having a 'much higher' or 'little higher' risk perception of osteoporosis and fractures. A poorer BMD result was associated with higher concern and higher risk perceptions. The presence of comorbidities, having ≥2 falls in the preceding year and maternal osteoporosis were associated with higher concern. Maternal osteoporosis, presence of comorbidities, weight loss of ≥5 kg in the preceding year and low body mass index were associated with higher perceptions of osteoporosis risk.

CONCLUSION

Women's concern and risk perception of osteoporosis and osteoporotic fractures were reasonably well founded. However, increasing age, height loss, smoking and drinking were not associated with concern and perception despite being known osteoporosis risk factors. These factors should be considered in planning for education and awareness raising programmes.

Osteoarthritis, osteoporosis, and exercise

With the aging of the work force, occupational health nurses must prepare for encounters with clients who are challenged by osteoarthritis or osteoporosis. Clients should be encouraged to exercise safely to promote functioning at home and work. This article reviews recent literature on the benefits of exercise for workers with osteoarthritis, osteoporosis, or both.