Disparities in osteoporosis treatments

Liu, Z.; Weaver, Jerusha; Papp, Anne E. de; Li, Z.; Martin, J. C.; Allen, Katie; Hui, Siu L.; Imel, Erik A.

doi:10.1007/s00198-015-3249-0

Cited by 35 publications

(31 citation statements)

References 36 publications

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“…But screening rates remain low (7-year cumulative incidence rates of 42.7 to 58.8 %) [13] despite Medicare’s covering DXA testing every 2 years and encouraging it as part of the one-time-only “Welcome to Medicare” and the annual “Wellness” visits [14] and notwithstanding the inclusion by the National Committee for Quality Assurance (NCQA) of two Health Effectiveness Data and Information Set (HEDIS) measures (OTO and OMW) for osteoporosis screening [15]. Pharmacological treatment rates are even lower, with a 2005–2011 Indiana study of 36,965 patients reporting that only 23.3 % received pharmacological treatment within 2 years of an osteoporosis diagnosis or a fragility fracture (82.2 % of whom were on oral bisphosphonates) [16], and a 2002–2011 USA study of 96,887 patients hospitalized for hip fracture reporting that only 28.5 % had received pharmacological treatment within 12 months post-discharge [9]. Furthermore, both studies documented important declines in pharmacological treatment rates over the course of their observation periods.…”

Section: Introductionmentioning

confidence: 99%

Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial

et al. 2016

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Summary Patients often do not know or understand their bone density test results, and pharmacological treatment rates are low. In a clinical trial of 7749 patients, we used a tailored patient-activation result letter accompanied by a bone health brochure to improve appropriate pharmacological treatment. Treatment rates, however, did not improve. Introduction Patients often do not know or understand their dual-energy x-ray absorptiometry (DXA) test results, which may lead to suboptimal care. We tested whether usual care augmented by a tailored patient-activation DXA result letter accompanied by an educational brochure would improve guideline-concordant pharmacological treatment compared to usual care only. Methods We conducted a randomized, controlled, double-blinded, pragmatic clinical trial at three health care centers in the USA. We randomized 7749 patients ≥50 years old and presenting for DXA between February 2012 and August 2014. The primary clinical endpoint at 12 and 52 weeks post-DXA was receiving guideline-concordant pharmacological treatment. We also examined four of the steps along the pathway from DXA testing to that clinical endpoint, including (1) receiving and (2) understanding their DXA results and (3) having subsequent contact with their provider and (4) discussing their results and options. Results Mean age was 66.6 years, 83.8 % were women, and 75.3 % were non-Hispanic whites. Intention-to-treat analyses revealed that guideline-concordant pharmacological treatment was not improved at either 12 weeks (65.1 vs. 64.3 %, p = 0.506) or 52 weeks (65.2 vs. 63.8 %, p = 0.250) post-DXA, even though patients in the intervention group were more likely (all p < 0.001) to recall receiving their DXA results letter at 12 weeks, correctly identify their results at 12 and 52 weeks, have contact with their provider at 52 weeks, and have discussed their results with their provider at 12 and 52 weeks. Conclusion A tailored DXA result letter and educational brochure failed to improve guideline-concordant care in patients who received DXA.

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Section: Introductionmentioning

confidence: 99%

Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial

et al. 2016

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“…Despite the availability of highly efficacious treatments for osteoporosis such as oral bisphosphonates, low treatment initiation rates [5] and low adherence among patients in clinical settings [6] limits the benefits. In clinical trials, osteoporosis agents decrease hip fractures by up to 50%, vertebral fractures by 30-70% (depending on whether detected based on clinical symptoms or morphometry), and nonvertebral fractures by up to 30% [7,8].…”

Section: Introductionmentioning

confidence: 99%

Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates

Imel

Eckert

Modi

et al. 2016

Bone

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“…Screening rates are also low with 40% of all women on Medicare reporting that they have never had a DXA (14), even though Medicare covers and encourages such testing every two years (15). Pharmacological treatment rates are even lower, with recent estimates reporting that only 23.3% received pharmacological treatment within two years of an osteoporosis diagnosis or any fragility fracture (16), and that only 28.5% received pharmacological treatment after discharge from a hip fracture (17), with both studies showing that treatment rates declined over time.…”

Section: Introductionmentioning

confidence: 99%

Activating Patients With a Tailored Bone Density Test Results Letter and Educational Brochure: the PAADRN Randomized Controlled Trial

Wolinsky

Lou

Edmonds

et al. 2017

Journal of Clinical Densitometry

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Background In cross-sectional studies, patient activation has been associated with better health behaviors, health outcomes, and health care experiences. Moreover, tailored interventions have led to clinically meaningful improvements in patient activation, as well as health outcomes over time. We tested whether a tailored patient-activation letter communicating bone mineral density (BMD) test results plus an educational brochure improved patient activation scores and levels at 12- and 52-weeks post-baseline as the mechanism leading to enhanced bone healthcare. Methodology In a randomized, controlled, double-blinded, multi-center pragmatic clinical trial we randomized 7,749 patients ≥ 50 years old and presenting for BMD testing at three medical centers in the United States between February 2012 and August 2014. The outcome measures were patient activation scores and levels based on six-items taken from the Patient Activation Measure (PAM) that were administered at the baseline, 12-week, and 52-week follow-up interviews. Results Mean age was 66.6 years, 83.8% were women, and 75.3% were Non-Hispanic-Whites. Overall, PAM activation scores improved from 58.1 at baseline to 76.4 by 12-weeks (p < 0.001) and to 77.2 (p = 0.002) by 52-weeks post-baseline. These improvements, however, were not significantly different between the intervention and usual care groups (18.7 vs. 18.1, p = 0.176, at 12-weeks) in intention-to-treat analyses. Conclusion PAM activation scores and levels substantially improved at 12-weeks and 52-weeks, but no differences were observed in these improvements between the intervention and usual care groups. These null findings may have occurred because the tailoring focused on the patient’s BMD and fracture risk results, rather than on the patient’s BMD and fracture risk results as well as the patient’s baseline PAM activation scores or levels.

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Disparities in osteoporosis treatments

Abstract: Most osteoporosis treatment candidates remained untreated. Men, black patients, and patients with fracture or chronic comorbidities were less likely to receive treatment, representing disparity in the recognition and treatment of osteoporosis.

Cited by 35 publications

References 36 publications

Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial

Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial

Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates

Activating Patients With a Tailored Bone Density Test Results Letter and Educational Brochure: the PAADRN Randomized Controlled Trial

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