title: Factors influencing the pharmacological management of osteoporosis after fragility fracture: results from the Ontario Osteoporosis Strategy's fracture clinic screening program.
abstract: 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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada, beatond@smh.ca.
authors.forename: D E
authors.initials: DE
authors.lastname: Beaton
authors.forename: S
authors.initials: S
authors.lastname: Dyer
authors.forename: D
authors.initials: D
authors.lastname: Jiang
authors.forename: R
authors.initials: R
authors.lastname: Sujic
authors.forename: M
authors.initials: M
authors.lastname: Slater
authors.forename: J E M
authors.initials: JE
authors.lastname: Sale
authors.forename: E R
authors.initials: ER
authors.lastname: Bogoch
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000379:methods; D055118:Medication Adherence; D008875:Middle Aged; D020380:Needs Assessment; D009864:Ontario; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D058866:Osteoporotic Fractures / Q000503:physiopathology / Q000517:prevention & control*; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D050071:Bone Density Conservation Agents