Patients reject the concept of fragility fracture--a new understanding based on fracture patients' communication.
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.


BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael's, 30 Bond Street, Toronto, ON, Canada, M5B 1W8. salej@smh.ca
J E M
JE
Sale
M A
MA
Gignac
L
L
Frankel
G
G
Hawker
D
D
Beaton
V
V
Elliot-Gibson
E
E
Bogoch
D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003142:Communication; D032882:Comprehension; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000523:psychology*; D006801:Humans; D008297:Male; D009864:Ontario; D010024:Osteoporosis / Q000150:complications; D058866:Osteoporotic Fractures / Q000209:etiology / Q000523:psychology*; D010353:Patient Education as Topic; D011369:Professional-Patient Relations; D036301:Qualitative Research; D009626:Terminology as Topic