title: Critical impact of patient knowledge and bone density testing on starting osteoporosis treatment after fragility fracture: secondary analyses from two controlled trials.
abstract: Most patients are not treated for osteoporosis after their fragility fracture "teachable moment." Among almost 400 consecutive wrist fracture patients, we determined that better-than-average osteoporosis knowledge (adjusted odds = 2.6) and BMD testing (adjusted odds = 6.5) were significant modifiable facilitators of bisphosphonate treatment while male sex, working outside the home, and depression were major barriers.
  
  
  BACKGROUND
  In the year following fragility fracture, fewer than one quarter of patients are treated for osteoporosis. Although much is known regarding health system and provider barriers and facilitators to osteoporosis treatment, much less is understood about modifiable patient-related factors.
  
  
  METHODS
  Older patients with wrist fracture not treated for osteoporosis were enrolled in trials that compared a multifaceted intervention with usual care controls. Baseline data included a test of patient osteoporosis knowledge. We then determined baseline factors that independently predicted starting bisphosphonate treatment within 1 year.
  
  
  RESULTS
  Three hundred seventy-four patients were enrolled; mean age 64 years, 78 % women, 90 % white, and 54 % with prior fracture. Within 1 year, 86 of 374 (23 %) patients were treated with bisphosphonates. Patients who were treated had better osteoporosis knowledge at baseline (70 % correct vs 57 % for untreated, p < 0.001) than patients who remained untreated; conversely, untreated patients were more likely to be male, still working, and report depression. In fully adjusted models, osteoporosis knowledge was independently associated with starting bisphosphonates (adjusted OR 2.6, 95 %CI 1.3-5.3). Obtaining a BMD test (aOR 6.5, 95 %CI 3.4-12.2) and abnormal BMD results (aOR 34.5, 95 %CI 16.8-70.9) were strongly associated with starting treatment.
  
  
  CONCLUSIONS
  The most important modifiable facilitators of osteoporosis treatment in patients with fracture were knowledge and BMD testing. Specifically targeting these two patient-level factors should improve post-fracture treatment rates.
authors.affiliation: The Department of Medicine, University of Alberta in Edmonton, 5-134B Clinical Sciences Building, 11350-83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada, me2.majumdar@ualberta.ca.
authors.forename: S R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: F A
authors.initials: FA
authors.lastname: McAlister
authors.forename: J A
authors.initials: JA
authors.lastname: Johnson
authors.forename: D L
authors.initials: DL
authors.lastname: Weir
authors.forename: D
authors.initials: D
authors.lastname: Bellerose
authors.forename: D A
authors.initials: DA
authors.lastname: Hanley
authors.forename: A S
authors.initials: AS
authors.lastname: Russell
authors.forename: B H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000416:Alberta; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D004164:Diphosphonates / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D058866:Osteoporotic Fractures / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology*; D014954:Wrist Injuries / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates