title: Low acceptance of treatment in the elderly for the secondary prevention of osteoporotic fracture in the acute rehabilitation setting.
abstract: OBJECTIVE
  Given the high risk of subsequent fracture among elderly persons with fracture, it is important to initiate secondary treatment for osteoporosis. Acute rehabilitation centers may offer a unique opportunity to introduce treatment. Therefore, we evaluated willingness-to-participate and compliance with evidence-based interventions for the secondary prevention of osteoporotic fracture in a non-randomized study conducted in the acute rehabilitation setting. We also described differences in baseline characteristics between study participants and non-participants.
  
  
  METHODS
  All consecutive, community dwelling admissions to an acute rehabilitation unit (Boston, MA) with the diagnosis of fracture were screened for enrollment. Eligible subjects were offered a free, 6-month supply of alendronate/cholecalciferol (70 mg/2800 IU weekly), calcium and vitamin D supplements, and fall prevention strategies. Six-month compliance (> or =75% consumption of medication or supplement) with the interventions was determined at a home visit.
  
  
  RESULTS
  Among 62 eligible subjects, 25 agreed to participate. Non-participants were older than participants (86 vs 80 yrs, p<0.01). There was no significant difference between other characteristics of participants and non-participants including sex, weight, type of fracture, cognitive status, and functional status. The most common reason for non-participation was reluctance to take another medication. Among participants, only 52% were compliant with alendronate and 58% were compliant with calcium and vitamin D supplementation at 6 months.
  
  
  CONCLUSIONS
  Willingness- to-participate and compliance with secondary prevention strategies for osteoporosis was low in the acute rehabilitation setting, even when medications were provided free of cost. Educating individuals with fracture and their families on the consequences and treatment of osteoporosis may help to decrease the risk of sustaining a second fracture by accepting secondary preventive measures.
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, MA 02131, USA. sarahberry@hrca.harvard.edu
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Berry
authors.forename: Devyani
authors.initials: D
authors.lastname: Misra
authors.forename: Marian T
authors.initials: MT
authors.lastname: Hannan
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Kiel
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000627:therapeutic use; D002762:Cholecalciferol / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control / Q000534:rehabilitation; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000534:rehabilitation; D010342:Patient Acceptance of Health Care; D045808:Refusal to Participate; D012047:Rehabilitation Centers; D014807:Vitamin D / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D014815:Vitamins; D014807:Vitamin D; D002762:Cholecalciferol; D002118:Calcium; D019386:Alendronate