Abstract
Summary
This study aimed to describe treatment initiation rates for men who had recently sustained a fracture. Most (75.9%) men potentially eligible for subsidised treatment at the time of fracture remained untreated even after a subsequent fracture.
Introduction
This study aimed to describe treatment initiation rates for men who had recently sustained a fracture.
Methods
The study was conducted as part of the Geelong Osteoporosis Study in south-eastern Australia. Men in the study area who had sustained an incident fracture in the period July 2006 to December 2007 were identified from hospital radiology reports. A self-report questionnaire was sent to eligible participants approximately 12 months after fracture. Respondents were asked for details of medications prescribed for ‘osteoporosis/fracture/low bone mass’ before and after fracture, and where applicable, reasons for cessation of treatment. We analysed the results for 109 men aged 50 years and older who had sustained fracture in the study period.
Results
Most (75.9%) men potentially eligible for subsidised treatment at the time of fracture remained untreated. Of the 87 men who were untreated, nine had osteoporosis at the hip and/or spine and 29 (26.6%) reported having sustained a low trauma prior fracture.
Conclusions
Our findings are consistent with previously published data showing low rates of treatment initiation in men eligible for osteoporosis treatment. There appear to be barriers involving participants’ and medical practitioners’ knowledge, beliefs and attitudes regarding osteoporosis and treatment, as well as in the doctor–patient partnership in osteoporosis management. Establishment of clinical pathways for fracture management beyond orthopaedic care may be one of a range of appropriate responses.
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References
Seeman E, Eisman JA (2004) Treatment of osteoporosis: why, whom, when and how to treat. Med J Aust 180:298–303
Pasco JA, Sanders KM, Hoekstra FM, Henry MJ, Nicholson GC, Kotowicz MA (2005) The human cost of fracture. Osteoporos Int 16:2046–2052
Sanders KM, Nicholson GC, Ugoni AM, Pasco JA, Seeman E, Kotowicz MA (1999) Health burden of hip and other fractures in Australia beyond 2000. Med J Aust 170:467–470
Smith JA (2007) Beyond masculine stereotypes: moving men's health promotion forward in Australia. Health Promot J Aust 18:20–25
Seeman E (1995) The dilemma of osteoporosis in men. Am J Med 98:76S–88S
Tuck SP, Datta HK (2007) Osteoporosis in the aging male: treatment options. Clin Interv Aging 2:521–536
Cheng N, Green ME (2008) Osteoporosis screening for men: are family physicians following the guidelines? Can Fam Physician 54:1140–1145
Ebeling P (2008) Osteoporosis in men. N Engl J Med 358:1474–1482
Seeman E, Bianchi G, Adami S, Kanis J, Khosla S, Orwoll E (2004) Osteoporosis in men—consensus is premature. Calcif Tissue Int 75:120–122
Seeman E, Bianchi G, Khosla S, Kanis JA, Orwoll E (2006) Bone fragility in men—where are we? Osteoporos Int 17:1577–1583
Seeman E (2001) Unresolved issues in osteoporosis in men. Rev Endocr Metab Disord 2:45–64
Kotowicz MA, Sarah B, Pasco JA, Henry MJ, Sanders KM, Korn S, Nicholson GC (2001) Sex bias in referral for bone densitometry. In First Joint Meeting of the International Bone and Mineral Society and the European Calcified Tissue Society. Elsevier, Madrid, p S237
Henry MJ, Pasco JA, Korn S, GIbson J, Kotowicz MA, Nicholson GC (in press) Bone mineral density reference ranges for Australian men: Geelong Osteoporosis Study. Osteoporos Int
Kaufmann JM, Orwoll E, Goemaere S, San Martin J, Hossain A, Dalsky GP, Lindsay R, Mitlak BH (2005) Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int 16:510–516
Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J, Adami S, Weber K, Lorenc R, Pietschmann P, Vandormael K, Lombardi A (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610
Ringe JD, Faber H, Farahmand P, Dorst A (2005) Efficacy of risedronate in men with primary and secondary osteoporosis: results of a 1-year study. Rheumatol Int 26(5):427–431
Finklestein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM (2003) The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 349(13):1216–1226
Lyles KW, Colón-Emeric CS, Magaziner JS (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357(18):1799–1809
Lekkerkerker F, Kanis JA, Alsayed N, Bouvenot G, Burlet N, Cahall D, Chines A, Delmas P, Dreiser RL, Ethgen D, Hughes N, Kaufmann JM, Korte S, Kreutz G, Laslop A, Mitlak B, Rabenda V, Rizzoli R, Santora A, Schimmer R, Tsouderos Y, Viethel P, Reginster JY (2007) Adherence to treatment of osteoporosis: a need for study. Osteoporos Int 18:1311–1317
Rossini M, Bianchi G, Di Munno O, Giannini S, Minisola S, Sinigaglia L, Adami S (2006) Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int 17:914–921
Gold DT, Silverman S (2006) Review of adherence to medications for the treatment of osteoporosis. Curr Osteopor Rep 4:21–27
Pasco JA, Henry MJ, Gundry TM et al (1999) Identification of incident fractures: the Geelong Osteoporosis Study. Aust N Z J Med 29:203–206
Pasco JA, Henry MJ, Korn S, Nicholson GC, Kotowicz MA (2009) Morphometric vertebral fractures of the lower thoracic and lumbar spine, physical function and quality of life in men. Osteoporos Int 20(5):787–792
World Medical Association (2008) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects
Edwards BJ, Bunta AD, Simonelli C, Bolander M, Fitzpatrick LA (2007) Prior fractures are common in patients with subsequent hip fractures. Clin Orthop Relat Res 461:226–230
Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD (2007) Patient adherence to osteoporosis medications: problems, consequences and management strategies. Drugs Aging 24:37–55
Center JR, Nguyen TV, Scheider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 453:878–882
Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Jt Surg Am 88-A:25–34
Taylor JC, Sterkel B, Utley M, Shipley M, Newman S, Horton M, Fitz-Clarence H (2001) Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management. Osteoporos Int 12:844–848
Elliott RA, Ross-Degnan D, Adams AS, Safran DG, Soumerai SB (2007) Strategies for coping in a complex world: adherence behavior among older adults with chronic illness. Soc Gen Intern Med 461:805–810
Acknowledgements
Support for the study was provided by the National Health and Medical Research Council. We thank Ms Rosalynn Korn for obtaining and entering questionnaire data.
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Otmar, R., Henry, M.J., Kotowicz, M.A. et al. Patterns of treatment in Australian men following fracture. Osteoporos Int 22, 249–254 (2011). https://doi.org/10.1007/s00198-010-1204-7
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DOI: https://doi.org/10.1007/s00198-010-1204-7