Postmenopausal women with minimal trauma fractures are unapprised of the existence of low bone mass or osteoporosis.
OBJECTIVE
To explore barriers to medical care for osteoporosis following a minimal trauma fracture (MTF). MTFs occur from a fall while in a seated, recumbent or standing position; during normal walking, or from a height less than 4 feet.


METHODS
Prospective study and focus groups of women with MTF performed in Chicago from June to December of 2003. Study protocol approved by Institutional Review Board (IRB) and all participants signed consent forms. Focus groups were audiotaped and transcribed, transcripts analyzed using Atlas.ti. Survey results analyzed with SPSS 11.5.


RESULTS
Twenty nine participants recruited with average age of 74+/-16 years. MTF occurred at the mean age of 61+/-8 years, with fifteen (15/29) reporting more that one prior MTF. The age distribution was 40-49 years 2 (2/29) participants, 50-59 years 2 (2/29), 60-69 years 6 (6/29), 70-79 years 10 (10/29), 80 and above 9 (9/29). Most participants (21/29, 70%) reported knowledge about osteoporosis obtained from written media. Osteoporotic fractures were rated on a single item Likert Scale (1=not important to 5=most important) as 2.5 (compared with breast cancer 2.3, and myocardial infarction 2.8). Half (16/29) had osteoporosis counseling with their PCP and 9 were receiving medications for bone loss. We observed a positive correlation between osteoporosis counseling and BMD testing (r=0.6, p<0.001), and a trend toward osteoporosis treatment (r=0.372, p=0.09). Half of the participants had reported the occurrence of MTF to their PCP (14/29), however this did not lead to counseling, BMD testing (r=0.07, p=0.78), or treatment (r=-0.14, p=0.53). None of the women believed that low BMD or osteoporosis had contributed to their fracture. Women studied believed that they were "too young" (12/29) to have osteoporosis.


CONCLUSIONS
Women are not receiving adequate information about osteoporosis; they remain unaware of the connection between MTFs and osteoporosis. Post-menopausal women with MTF do not identify osteoporosis as a cause for the fracture, may exhibit ageism and thereby fail to seek adequate medical care.
Edwards
Beatrice J
BJ
Department of Medicine, The Feinberg School of Medicine Northwestern University, Bone Health and Osteoporosis Program, 676 N St Clair, Suite 200 Chicago, IL 60611, USA. bje168@northwestern.edu
Iris
Madelyn
M
Ferkel
Eric
E
Feinglass
Joseph
J
D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003266:Continuity of Patient Care; D005260:Female; D017144:Focus Groups; D050723:Fractures, Bone / Q000209:etiology* / Q000523:psychology / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000523:psychology; D017698:Postmenopause; D011446:Prospective Studies