title: What predicts initiation of osteoporosis treatment after fractures: education organisation or patients' characteristics?
abstract: OBJECTIVE
  Fracture events due to osteoporosis (OP) are a major health burden in an ageing population. Their diagnosis and treatment provides the opportunity to prevent further fractures. However, the identification and treatment of underlying OP is often unsatisfactory. This longitudinal observational study, attempts to understand the barriers hindering OP treatment initiation in patients entering our hospital for fragility fracture.
  
  
  METHODS
  349 patients with fragility fracture underwent OP education (interview with a trained nurse) and were offered further OP care either with their general physician (or private rheumatologist) or at the hospital. In the latter case, the patients were given an appointment for OP-centred investigation and consultation. Six months after the fracture they were contacted to know whether they had been investigated and had started a treatment for OP (outcome). The factors predicting the outcome were analysed.
  
  
  RESULTS
  The organisation of further OP care at the hospital yielded the highest probability of being treated (OR 118.09; 95%CI [13.93-1000.92]), while patient's education on OP had a slighter effect (OR 4.74; 95%CI [2.15-10.44]). A low social status was the strongest patient-related negative predictor of further treatment (OR 0.22 [95%CI 0.09-0.47]).
  
  
  CONCLUSIONS
  The organisation of patients' OP care is the strongest determinant of OP investigation and treatment after fracture, and this aspect should be considered when attempting to increase OP care in everyday practice. Patients having a low social status are less likely to be investigated and treated, and additional efforts to properly organise their care are warranted.
authors.affiliation: Department of Rheumatology, Paris-13 University, Bobigny, France. luca.semerano@avc.aphp.fr
authors.forename: Luca
authors.initials: L
authors.lastname: Semerano
authors.forename: Xavier
authors.initials: X
authors.lastname: Guillot
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.forename: Evelyne
authors.initials: E
authors.lastname: Avice
authors.forename: Thierry
authors.initials: T
authors.lastname: Bégué
authors.forename: Mathias
authors.initials: M
authors.lastname: Wargon
authors.forename: Marie-Christophe
authors.initials: MC
authors.lastname: Boissier
authors.forename: Nathalie
authors.initials: N
authors.lastname: Saidenberg-Kermanac'h
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003710:Demography; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D010349:Patient Compliance; D010353:Patient Education as Topic