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Dorcas E Beaton - One of the best experts on this subject based on the ideXlab platform.
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factors associated with screening positive for high falls risk in Fragility Fracture patients a cross sectional study
BMC Musculoskeletal Disorders, 2020Co-Authors: Dorcas E Beaton, Earl R. Bogoch, R Sujic, Nooshin K Rotondi, Taucha Inrig, Denise Linton, Jennifer WeldonAbstract:Background We sought to report the prevalence of Fragility Fracture patients who were screened at high falls risk using a large provincial database, and to determine the characteristics associated with being screened at high falls risk. Methods The study population included Fragility Fracture patients 50+ years of age who were screened at 35 hospital Fracture clinics in Ontario over a 3.5 year period. The outcome was based on two screening questions measuring the risk of falling, both adapted from the STEADI (Stopping Elderly Accidents, Deaths & Injuries) tool. Multivariable associations of sociodemographic, Fracture-related, and health-related characteristics were evaluated using logistic regression. Results Of the sample, 9735 (44.5%) patients were classified as being at high falls risk, and 12,089 (55.3%) were not. In the multivariable logistic regression, being 80+ years of age (vs. 50-64 years of age), non-community dwelling (vs. living with spouse, family member, roommate), having a mental/physical impairment (vs. none), and taking multiple medications, were all strongly associated with being screened at high falls risk. Conclusions Living in a non-community dwelling and taking 4+ medications were the variables most strongly associated with being screened at high falls risk. These are potentially modifiable characteristics that should be considered when assessing falls risk in Fragility Fracture patients, and particularly when designing interventions for preventing subsequent falls. Ongoing work to address the higher risk of falls in the Fragility Fracture population is warranted.
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improvements in osteoporosis testing and care are found following the wide scale implementation of the ontario Fracture clinic screening program an interrupted time series analysis
Medicine, 2017Co-Authors: Dorcas E Beaton, Earl R. Bogoch, Joanna E. M. Sale, R Sujic, Susan B Jaglal, Muhammad Mamdani, Hong Zheng, Suzanne M Cadarette, Ravi JainAbstract:AbstractWe evaluated a system-wide impact of a health intervention to improve treatment of osteoporosis after a Fragility Fracture. The intervention consisted of assigning a screening coordinator to selected Fracture clinics to identify, educate, and follow up with Fragility Fracture patients and in
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equal treatment no evidence of gender inequity in osteoporosis management in a coordinator based Fragility Fracture screening program
Osteoporosis International, 2017Co-Authors: H Ansari, Dorcas E Beaton, Joanna E. M. Sale, R Sujic, Nooshin Khobzi Rotondi, John D Cullen, Morgan Slater, Rakesh K JainAbstract:We evaluated gender imbalance in osteoporosis management in a provincial coordinator-based Fracture prevention program and found no difference by gender in treatment of high-risk Fragility Fracture patients. This establishes that a systemic approach with interventions for all Fragility Fracture patients can eliminate the gender inequity that is often observed. The purpose of this study was to evaluate an Ontario-based Fracture prevention program for its ability to address the well-documented gender imbalance in osteoporosis (OP) management, by incorporating its integrated Fracture risk assessments within a needs-based evaluation of equity. Fragility Fracture patients (≥ 50 years) who were treatment naive at screening and completed follow-up within 6 months of screening were studied. Patients who underwent bone mineral density (BMD) testing done in the year prior to their current Fracture were excluded. All participants had BMD testing conducted through the Ontario OP Strategy Fracture Screening and Prevention program, thus providing us with Fracture risk assessment data. Our primary study outcome was treatment initiation at follow-up within 6 months of screening. Gender differences were compared using Fisher’s exact test, at p 0.05). 68.4% of women and 66.2% of men at high risk were treated within 6 months of screening. Needs-based analyses show no difference by gender in treatment of high-risk Fragility Fracture patients. An intensive coordinator-based Fracture prevention model adopted in Ontario, Canada was not associated with gender inequity in OP treatment of Fragility Fracture patients after Fracture risk adjustment.
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comparison of caroc and frax in Fragility Fracture patients agreement clinical utility and implications for clinical practice
The Journal of Rheumatology, 2016Co-Authors: Nooshin Khobzi Rotondi, Dorcas E Beaton, Rebeka Sujic, Joanna E. M. Sale, Victoria Elliotgibson, Robert G Josse, William D Leslie, Earl R. BogochAbstract: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.
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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
Osteoporosis International, 2014Co-Authors: Dorcas E Beaton, Earl R. Bogoch, Joanna E. M. Sale, R Sujic, Morgan Slater, S Dyer, D JiangAbstract: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. 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. 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. 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. 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.
Earl R. Bogoch - One of the best experts on this subject based on the ideXlab platform.
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factors associated with screening positive for high falls risk in Fragility Fracture patients a cross sectional study
BMC Musculoskeletal Disorders, 2020Co-Authors: Dorcas E Beaton, Earl R. Bogoch, R Sujic, Nooshin K Rotondi, Taucha Inrig, Denise Linton, Jennifer WeldonAbstract:Background We sought to report the prevalence of Fragility Fracture patients who were screened at high falls risk using a large provincial database, and to determine the characteristics associated with being screened at high falls risk. Methods The study population included Fragility Fracture patients 50+ years of age who were screened at 35 hospital Fracture clinics in Ontario over a 3.5 year period. The outcome was based on two screening questions measuring the risk of falling, both adapted from the STEADI (Stopping Elderly Accidents, Deaths & Injuries) tool. Multivariable associations of sociodemographic, Fracture-related, and health-related characteristics were evaluated using logistic regression. Results Of the sample, 9735 (44.5%) patients were classified as being at high falls risk, and 12,089 (55.3%) were not. In the multivariable logistic regression, being 80+ years of age (vs. 50-64 years of age), non-community dwelling (vs. living with spouse, family member, roommate), having a mental/physical impairment (vs. none), and taking multiple medications, were all strongly associated with being screened at high falls risk. Conclusions Living in a non-community dwelling and taking 4+ medications were the variables most strongly associated with being screened at high falls risk. These are potentially modifiable characteristics that should be considered when assessing falls risk in Fragility Fracture patients, and particularly when designing interventions for preventing subsequent falls. Ongoing work to address the higher risk of falls in the Fragility Fracture population is warranted.
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improvements in osteoporosis testing and care are found following the wide scale implementation of the ontario Fracture clinic screening program an interrupted time series analysis
Medicine, 2017Co-Authors: Dorcas E Beaton, Earl R. Bogoch, Joanna E. M. Sale, R Sujic, Susan B Jaglal, Muhammad Mamdani, Hong Zheng, Suzanne M Cadarette, Ravi JainAbstract:AbstractWe evaluated a system-wide impact of a health intervention to improve treatment of osteoporosis after a Fragility Fracture. The intervention consisted of assigning a screening coordinator to selected Fracture clinics to identify, educate, and follow up with Fragility Fracture patients and in
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comparison of caroc and frax in Fragility Fracture patients agreement clinical utility and implications for clinical practice
The Journal of Rheumatology, 2016Co-Authors: Nooshin Khobzi Rotondi, Dorcas E Beaton, Rebeka Sujic, Joanna E. M. Sale, Victoria Elliotgibson, Robert G Josse, William D Leslie, Earl R. BogochAbstract: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.
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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
Osteoporosis International, 2014Co-Authors: Dorcas E Beaton, Earl R. Bogoch, Joanna E. M. Sale, R Sujic, Morgan Slater, S Dyer, D JiangAbstract: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. 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. 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. 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. 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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Bone mineral density testing after Fragility Fracture
Canadian Family Physician, 2013Co-Authors: Joshua Posen, Dorcas E Beaton, Joanna E. M. Sale, Earl R. BogochAbstract:Objective To determine the proportion of patients with Fragility Fractures who can be expected to have low bone mineral density (BMD) at the time of Fracture and to assist FPs in deciding whether to refer patients for BMD testing. Data sources MEDLINE, EMBASE, and CINAHL were searched from the earliest available dates through September 2009. Study selection English-language articles reporting BMD test results of patients with Fragility Fractures who were managed in an orthopedic environment (eg, Fracture clinic, emergency management by orthopedic surgeons, inpatients) were eligible for review. While the orthopedic environment has been identified as an ideal point for case finding, FPs are often responsible for investigation and treatment. Factors that potentially influenced BMD test results (eg, selection of Fracture types, exclusion criteria) were identified. Studies with 2 or more selection factors of potential influence were flagged, and rates of low BMD were calculated including and excluding these studies. Synthesis The distribution of the proportion of persons with low BMD was summarized across studies using descriptive statistics. We calculated lower boundaries on this distribution, using standard statistical thresholds, to determine a lower threshold of the expected rate of low BMD. Conclusion Family physicians evaluating patients with Fragility Fractures can expect that at least two-thirds of patients with Fragility Fractures who are older than 50 years of age will have low BMD (T score ≤ −1.0). With this a priori expectation, FPs might more readily conduct a Fracture risk assessment and pursue warranted Fracture risk reduction strategies following Fragility Fracture.
Joanna E. M. Sale - One of the best experts on this subject based on the ideXlab platform.
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long term experiences of pain after a Fragility Fracture
Osteoporosis International, 2018Co-Authors: A Gheorghita, Joanna E. M. Sale, Fiona Webster, Stephen ThielkeAbstract:Little is known about long-term pain after a Fragility Fracture. In this secondary analysis, we determined that pain continues to influence many patients’ lives more than 1 year after a Fracture and that health care providers do not seem to adequately recognize or manage these long-term consequences. We characterized perspectives on long-term pain among men and women who had sustained a Fragility Fracture. We conducted a secondary analysis of qualitative data from 67 individuals recruited in three primary studies (47–89 years old; 55 women, 12 men). Eligible individuals from the primary studies were those who had reported pain related to their Fracture beyond 6 months. Data about reported pain were re-analyzed using qualitative description as articulated by Sandelowski. Thirty-four individuals (47–89 years old; 4 men; 8 had sustained a vertebral Fracture) reported pain related to their Fracture in the primary studies. Thirty-one (91%) participants had sustained a Fragility Fracture at least 1 year previously (range 1–13 years). Patients described long-term pain beyond typical Fracture healing times, generally unrelieved by analgesics, which affected their mobility, functional activity, independence, sleep, and energy. Health care providers were perceived to under-estimate timelines regarding the decrease of post-Fracture pain and to not manage that pain. Participants reported that pain management was inadequate and that they developed their own strategies to respond to it. Pain continues to influence many patients’ lives more than 1 year after a Fragility Fracture. Patient narratives could be useful to help health care providers to better recognize and manage this long-term consequence of Fractures.
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improvements in osteoporosis testing and care are found following the wide scale implementation of the ontario Fracture clinic screening program an interrupted time series analysis
Medicine, 2017Co-Authors: Dorcas E Beaton, Earl R. Bogoch, Joanna E. M. Sale, R Sujic, Susan B Jaglal, Muhammad Mamdani, Hong Zheng, Suzanne M Cadarette, Ravi JainAbstract:AbstractWe evaluated a system-wide impact of a health intervention to improve treatment of osteoporosis after a Fragility Fracture. The intervention consisted of assigning a screening coordinator to selected Fracture clinics to identify, educate, and follow up with Fragility Fracture patients and in
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equal treatment no evidence of gender inequity in osteoporosis management in a coordinator based Fragility Fracture screening program
Osteoporosis International, 2017Co-Authors: H Ansari, Dorcas E Beaton, Joanna E. M. Sale, R Sujic, Nooshin Khobzi Rotondi, John D Cullen, Morgan Slater, Rakesh K JainAbstract:We evaluated gender imbalance in osteoporosis management in a provincial coordinator-based Fracture prevention program and found no difference by gender in treatment of high-risk Fragility Fracture patients. This establishes that a systemic approach with interventions for all Fragility Fracture patients can eliminate the gender inequity that is often observed. The purpose of this study was to evaluate an Ontario-based Fracture prevention program for its ability to address the well-documented gender imbalance in osteoporosis (OP) management, by incorporating its integrated Fracture risk assessments within a needs-based evaluation of equity. Fragility Fracture patients (≥ 50 years) who were treatment naive at screening and completed follow-up within 6 months of screening were studied. Patients who underwent bone mineral density (BMD) testing done in the year prior to their current Fracture were excluded. All participants had BMD testing conducted through the Ontario OP Strategy Fracture Screening and Prevention program, thus providing us with Fracture risk assessment data. Our primary study outcome was treatment initiation at follow-up within 6 months of screening. Gender differences were compared using Fisher’s exact test, at p 0.05). 68.4% of women and 66.2% of men at high risk were treated within 6 months of screening. Needs-based analyses show no difference by gender in treatment of high-risk Fragility Fracture patients. An intensive coordinator-based Fracture prevention model adopted in Ontario, Canada was not associated with gender inequity in OP treatment of Fragility Fracture patients after Fracture risk adjustment.
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the theory of planned behaviour explains intentions to use antiresorptive medication after a Fragility Fracture
Rheumatology International, 2017Co-Authors: Joanna E. M. Sale, Stephen Thielke, Cathy Cameron, Lynn M MeadowsAbstract:Our objective was to ascertain whether the Theory of Planned Behaviour (TPB) explains patient intentions to use antiresorptive medication after a Fracture. A qualitative study was conducted with English-speaking members of the Canadian Osteoporosis Patient Network (COPN) who had sustained a Fragility Fracture at 50+ years of age and were not taking antiresorptive medication at the time of that Fracture. Questions during a 1-h telephone interview were guided by the domains of the TPB: they addressed the antecedent constructs regarding antiresorptive medication (attitudes, subjective norms, and perceived behavioural control) as well as intentions regarding antiresorptive medication use. We created a coding template a priori based on the TPB domains and applied this template to the interview data. Twenty-six eligible participants (24 females, 2 males) aged 51-89 completed an interview. The TPB appeared to be predictive of intentions in 19 (73%) participants. In the majority of participants where the TPB did not appear to be predictive (57%), a positive attitude toward antiresorptive medication was the most important antecedent variable in determining intentions. The TPB appeared to be predictive of intentions to use antiresorptive medication among individuals who had experienced a Fragility Fracture. Attitudes towards medication were especially important.
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comparison of caroc and frax in Fragility Fracture patients agreement clinical utility and implications for clinical practice
The Journal of Rheumatology, 2016Co-Authors: Nooshin Khobzi Rotondi, Dorcas E Beaton, Rebeka Sujic, Joanna E. M. Sale, Victoria Elliotgibson, Robert G Josse, William D Leslie, Earl R. BogochAbstract: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.
Bruce H Mitlak - One of the best experts on this subject based on the ideXlab platform.
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sustained nonvertebral Fragility Fracture risk reduction after discontinuation of teriparatide treatment
Journal of Bone and Mineral Research, 2005Co-Authors: Richard L Prince, Adrien Sipos, Anwar Hossain, Unni Syversen, Sophia Ishshalom, Ewa Marcinowska, Johan Halse, Robert Lindsay, Gail P Dalsky, Bruce H MitlakAbstract:UNLABELLED: A follow-up in 1262 women was conducted after the discontinuation of teriparatide. The hazard ratio for combined teriparatide group (20 and 40 microg) for the 50-month period after baseline was 0.57 (p = 0.002), suggesting a sustained effect in reducing the risk of nonvertebral Fragility Fracture. INTRODUCTION: Treatment with teriparatide [rhPTH(1-34)] 20 and 40 microg once-daily subcutaneous dosing significantly reduced the risk of nonvertebral Fragility Fractures over a median exposure of 19 months. MATERIALS AND METHODS: All participants in the Fracture Prevention Trial were invited to participate in a follow-up study. Prior treatment assignments were revealed, and patients were able to receive osteoporosis treatments without restriction. RESULTS: Approximately 60% of the 1262 patients received an osteoporosis treatment at some time during follow-up, with greater use in the former placebo group than in the combined former teriparatide group (p < 0.05). The hazard ratios for nonvertebral Fragility Fractures in each teriparatide group relative to placebo were statistically significant for the 50-month period including treatment and follow-up (p < 0.03). In the follow-up period, the hazard ratio was significantly different between the 40 mug and combined groups versus placebo but not for the 20 microg group versus placebo. However, the 20 and 40 microg groups were not different from each other. Kaplan-Meier analysis of time to Fracture showed that the Fracture incidence in the former placebo and teriparatide groups diverged during the 50-month period including teriparatide treatment and follow-up (p = 0.009). Total hip and femoral neck BMD decreased in teriparatide-treated patients who had no follow-up treatment; BMD remained stable or further increased in patients who received a bisphosphonate after teriparatide treatment. CONCLUSIONS: While the study design is observational, the results support a sustained effect of teriparatide in reducing the risk of nonvertebral Fragility Fractures up to 30 months after discontinuation of treatment.
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sustained nonvertebral Fragility Fracture risk reduction after discontinuation of teriparatide treatment
Journal of Bone and Mineral Research, 2005Co-Authors: Richard L Prince, Adrien Sipos, Anwar Hossain, Unni Syversen, Sophia Ishshalom, Ewa Marcinowska, Johan Halse, Robert Lindsay, Gail P Dalsky, Bruce H MitlakAbstract:A follow-up in 1262 women was conducted after the discontinuation of teriparatide. The hazard ratio for combined teriparatide group (20 and 40 μg) for the 50-month period after baseline was 0.57 (p = 0.002), suggesting a sustained effect in reducing the risk of nonvertebral Fragility Fracture. Introduction: Treatment with teriparatide {rhPTH(1-34)} 20 and 40 μg once-daily subcutaneous dosing significantly reduced the risk of nonvertebral Fragility Fractures over a median exposure of 19 months. Materials and Methods: All participants in the Fracture Prevention Trial were invited to participate in a follow-up study. Prior treatment assignments were revealed, and patients were able to receive osteoporosis treatments without restriction. Results: Approximately 60% of the 1262 patients received an osteoporosis treatment at some time during follow-up, with greater use in the former placebo group than in the combined former teriparatide group (p < 0.05). The hazard ratios for nonvertebral Fragility Fractures in each teriparatide group relative to placebo were statistically significant for the 50-month period including treatment and follow-up (p < 0.03). In the follow-up period, the hazard ratio was significantly different between the 40 μg and combined groups versus placebo but not for the 20 μg group versus placebo. However, the 20 and 40 μg groups were not different from each other. Kaplan-Meier analysis of time to Fracture showed that the Fracture incidence in the former placebo and teriparatide groups diverged during the 50-month period including teriparatide treatment and follow-up (p = 0.009). Total hip and femoral neck BMD decreased in teriparatide-treated patients who had no follow-up treatment; BMD remained stable or further increased in patients who received a bisphosphonate after teriparatide treatment. Conclusions: While the study design is observational, the results support a sustained effect of teriparatide in reducing the risk of nonvertebral Fragility Fractures up to 30 months after discontinuation of treatment.
Victoria Elliotgibson - One of the best experts on this subject based on the ideXlab platform.
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comparison of caroc and frax in Fragility Fracture patients agreement clinical utility and implications for clinical practice
The Journal of Rheumatology, 2016Co-Authors: Nooshin Khobzi Rotondi, Dorcas E Beaton, Rebeka Sujic, Joanna E. M. Sale, Victoria Elliotgibson, Robert G Josse, William D Leslie, Earl R. BogochAbstract: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.
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patients reject the concept of Fragility Fracture a new understanding based on Fracture patients communication
Osteoporosis International, 2012Co-Authors: Dorcas E Beaton, Joanna E. M. Sale, Monique A M Gignac, Gillian A Hawker, L Frankel, Victoria ElliotgibsonAbstract:We examined patients’ communication about Fragility Fractures to gain insight into why patients do not connect Fractures to bone health. The term “Fragility” Fracture was a misnomer to patients who perceived the event as physically and emotionally traumatic. Improved communication about such Fractures could facilitate awareness of bone health. We examined patients’ communication about Fragility Fractures to gain insight into why patients do not perceive the connection between their Fracture and low bone mass. A descriptive phenomenological (qualitative) study was conducted. During face-to-face interviews, the participants described the experience of their Fracture in detail and the circumstances surrounding the Fracture. Data analysis was guided by Giorgi’s methodology. English-speaking male and female patients aged 65+ years and “high” risk for future Fracture were eligible and screened for osteoporosis through an established screening program at an urban teaching hospital. We recruited 30 participants (9 males, 21 females), aged 65–88, who presented with a hip (n = 11), wrist (n = 11), shoulder (n = 6), or other (n = 2) Fracture. Ten of the 30 Fractures occurred inside the home and the remaining Fractures occurred outside the home. Sustaining a Fragility Fracture was perceived as a traumatic event, both physically and emotionally. In general, participants used forceful, action-oriented words and referred to hard surfaces to describe the experience. Explanations for the Fracture, other than bone quality, were often reported, especially that falls were “freak” or “fluke” events. Patients who sustained a Fracture under more mundane circumstances seemed more likely to perceive a connection between the Fracture and their bone health. The term Fragility Fracture was a misnomer for many older adults. By reexamining how this term is communicated to Fracture patients, health care providers may better facilitate patients’ awareness of bone health.
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systematic review on interventions to improve osteoporosis investigation and treatment in Fragility Fracture patients
Osteoporosis International, 2011Co-Authors: Dorcas E Beaton, Earl R. Bogoch, Joanna E. M. Sale, Victoria Elliotgibson, J. PosenAbstract:This study aims to determine osteoporosis (OP) investigation and treatment within post-Fracture initiatives conducted in Fracture clinics and other orthopedic environments. A systematic review was conducted. Eligibility criteria were: hip Fracture patients plus all other Fracture patients presenting with a Fragility Fracture, orthopedic setting where orthopedic physicians/staff were involved, intervention to improve OP management, primary data on ≥20 patients from randomized controlled trials (RCTs) and other study designs. We calculated outcome data within 6 months of screening from an intention-to-treat principle to derive an equated proportion (EP) across interventions. Outcomes were: (1) proportion of patients investigated with bone densitometry, (2) proportion of patients initiating OP medication, and (3) proportion of patients taking OP medication. We identified 2,259 citations, of which 57 articles that included 64 intervention groups were eligible. The median EP for patients investigated was 43% and the 75th percentile was 71%. The median EP for medication initiation was 22% and the 75th percentile was 34%. The median EP for medication taking was 27.5% and the 75th percentile was 43%. The EPs for all outcomes were higher for interventions with dedicated personnel to implement the intervention and those within which bone mineral density testing and/or treatment were included. In studies with an EP, up to 71% of patients were investigated for OP, but <35% initiated medication, and <45% were taking medication within 6 months of screening. Calculating an EP allowed us to compare outcomes across the studies, therefore capturing both RCTs and other study designs typical of real-world settings.
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effective initiation of osteoporosis diagnosis and treatment for patients with a Fragility Fracture in an orthopaedic environment
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Earl R. Bogoch, Dorcas E Beaton, Victoria Elliotgibson, Sophie A Jamal, Robert G Josse, T M MurrayAbstract:Background: Fragility Fractures resulting from osteoporosis are common injuries. However, the identification and treatment of osteoporosis in these high-risk patients are widely reported to be inadequate. The goals of this study were to determine how many patients receiving inpatient or outpatient treatment for a Fragility Fracture could be identified and enrolled in a program for osteoporosis education, investigation, and treatment and receive appropriate osteoporosis care within the program. Methods: An Osteoporosis Exemplary Care Program was implemented to identify, educate, evaluate, refer, and treat patients considered to be at risk for osteoporosis because of a typical Fragility Fracture. System modifications included coordination among the orthopaedic unit, Metabolic Bone Disease Clinic, and nuclear medicine unit to provide a continuum of care for these patients. Barriers were addressed through ongoing education of physicians, staff, and patients to increase knowledge and awareness of osteoporosis. The percentages of patients previously diagnosed and treated for osteoporosis, referred for investigation of osteoporosis, treated by the orthopaedic team, and receiving appropriate attention for osteoporosis were calculated. Risk factors for osteoporosis were also assessed. Results: Three hundred and forty-nine patients with a Fragility Fracture (221 outpatients and 128 inpatients) who met the inclusion criteria and an additional eighty-one patients with a Fracture (fifty-five outpatients and twenty-six inpatients) who did not meet the inclusion criteria but were suspected by their orthopaedic surgeons of having underlying osteoporosis were enrolled in the Osteoporosis Exemplary Care Program. More than 96% (414) of these 430 patients received appropriate attention for osteoporosis. Approximately one-third (146) of the 430 patients had been diagnosed and treated for osteoporosis before the time of recruitment. Two hundred and twenty-two of the remaining patients were referred to the Metabolic Bone Disease Clinic or to their family physician for further investigation and treatment for osteoporosis. Treatment was initiated by the orthopaedic team for another twenty-three patients. Many patients had risk factors for osteoporosis in addition to the Fragility Fracture; these included a previous Fracture (forty-nine of 187; 26%), a mother who had had a Fragility Fracture (forty-two of 188; 22%), or a history of smoking (105 of 188; 56%). Conclusions: In a coordinated post-Fracture osteoporosis education and treatment program directed at patients with a Fragility Fracture and their caregivers, >95% of patients were appropriately diagnosed, treated, or referred for osteoporosis care. To accomplish this, a dedicated coordinator and the full cooperation of orthopaedic surgeons and residents, orthopaedic technologists, allied health-care professionals (nurses, physical and occupational therapists, and social workers), and administrative staff were required.
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practice patterns in the diagnosis and treatment of osteoporosis after a Fragility Fracture a systematic review
Osteoporosis International, 2004Co-Authors: Victoria Elliotgibson, Earl R. Bogoch, Sophie A Jamal, Dorcas E BeatonAbstract:Fragility Fractures are a strong indicator of underlying osteoporosis (OP). With the risk of future Fracture being increased 1.5- to 9.5-fold following a Fragility Fracture, the diagnosis and treatment of OP in men and women with Fragility Fractures provides the opportunity to prevent future Fragility Fractures. This review describes the current status of practice in investigation and diagnosis of OP in men and women with Fragility Fractures, the rates and types of postFracture treatment in patients with Fragility Fractures and OP, interventions undertaken in this population, and the barriers to OP identification and treatment. A literature search performed in Medline, Healthstar, CINAHL, EMBASE, PreMedline, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews identified 37 studies on OP diagnosis, treatment, and interventions. The studies varied in design methodology, study facilities, types of Fractures, and pharmacological treatments. Some studies revealed that no patients with Fragility Fractures received investigation or treatment for underlying OP. Investigation of OP by bone mineral density was low: 14 of 16 studies reported investigation of less than 32% of patients. Investigation by bone mineral density resulted in high rates of OP diagnosis (35–100%), but only moderate use of calcium and vitamin D (8–62%, median 18%) and bisphosphoates (0.5–38%) in patients investigated postFracture. Studies on barriers to OP identification and treatment focused on various groups of health practitioners. Barriers included the cost of therapies, time and cost of resources for diagnosis, concerns about medications, and the lack of clarity regarding the responsibility to undertake this care.
