Low self-awareness of osteoporosis and fracture risk among postmenopausal women

Langer, Felipe Welter; Codevilla, Antonio Aurelio da Silveira; Bringhenti, Raisa; Osto, Léo Canterle Dal; Campos, Thabara; Martins, Tamires Tolazzi; Barin, Ana Elize; Rigo, Pietro Hagamenon; Boufleuer, Natalia Diel; Santinon, S.F.; Kipper, Kaira; Rodrigues, Juliano; Premaor, Melissa Orlandin

doi:10.1007/s11657-016-0266-3

Cited by 13 publications

(9 citation statements)

References 20 publications

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“…Self-perception of risk of a condition is a difficult concept, as it requires an individual to compare their own health status to others. There is evidence that self-perception of risk of osteoporosis and osteoporotic fractures is underestimated in postmenopausal women worldwide [6], and that self-perceived risks of osteoporosis and fracture affect certain behaviours such as seeking medical advice, anti-osteoporosis medication use and BMD screening, which might lead to greater healthcare engagement, treatment and altered bone health [5,7]. Furthermore, findings from the GLOW cohort suggest that increased self-perceived fracture risk is strongly associated with incident fracture rate [8].…”

Section: Introductionmentioning

confidence: 99%

Self-perceived Fracture Risk in the Global Longitudinal Study of Osteoporosis in Women: Its Correlates and Relationship with Bone Microarchitecture

et al. 2020

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The purpose of this study is to examine correlates of self-perceived fracture risk (SPR) and relationships between SPR and subsequent bone density and microarchitecture in the UK arm of the Global Longitudinal Study of Osteoporosis in Women. 3912 women completed baseline questionnaires detailing medical history and SPR; 492 underwent HRpQCT scans of the radius and tibia and DXA scans of total body, hip, femoral neck and lumbar spine a median of 7.5 years later. Correlates of SPR were examined and a cluster analysis of potential predictors of SPR performed. SPR in relation to HRpQCT and aBMD parameters was examined using linear regression with and without adjustment for anthropometric, demographic and lifestyle covariates. Mean (SD) baseline age was 69.0 (9.0) years; 56.6% reported a similar SPR; 28.6% lower SPR; 14.9% higher SPR compared to women of similar age. In mutually-adjusted analysis, higher SPR was associated (p < 0.05) with: lower physical activity and educational attainment; use of anti-osteoporosis medications (AOM) and calcium supplements; greater number of falls in the previous year; history of fracture since aged 45; family history of hip fracture; and increased comorbidity. Higher SPR, history of fracture, and use of AOM, calcium and vitamin D clustered together. Even after adjustments that included AOM use, higher SPR was associated with: lower radial trabecular volumetric density and number, and higher trabecular separation; lower tibial cortical area and trabecular volumetric density; and lower aBMD at the femoral neck. Despite greater AOM use, women with higher baseline SPR had poorer subsequent bone health.

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Section: Introductionmentioning

confidence: 99%

Self-perceived Fracture Risk in the Global Longitudinal Study of Osteoporosis in Women: Its Correlates and Relationship with Bone Microarchitecture

et al. 2020

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“…There has been increasing recognition of the need for patient education regarding secondary prevention following a fracture . Langer and colleagues recently surveyed more than 1000 patients and even among patients rated high risk for secondary fracture using the Fracture Risk Assessment Tool (FRAX) tool, most perceived their future fracture risk as low. In our own trial, patients did not recognize the need for further evaluation of their bone health after fracture .…”

Section: Discussionmentioning

confidence: 99%

Comparing Strategies Targeting Osteoporosis to Prevent Fractures After an Upper Extremity Fracture (C-STOP Trial): A Randomized Controlled Trial

Majumdar

McAlister

Johnson

et al. 2018

Journal of Bone and Mineral Research

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We compared osteoporosis care after upper extremity fragility fracture using a low-intensity Fracture Liaison Service (FLS) versus a high-intensity FLS in a pragmatic patient-level parallel-arm comparative effectiveness trial undertaken at a Canadian academic hospital. A low-intensity FLS (active-control) that identified patients and notified primary care providers was compared to a high-intensity FLS (case manager) where a specially-trained nurse identified patients, investigated bone health, and initiated appropriate treatment. A total of 361 community-dwelling participants 50 years or older with upper extremity fractures who were not on bisphosphonate treatment were included; 350 (97%) participants completed 6-month follow-up undertaken by assessors blinded to group allocation. The primary outcome was difference in bisphosphonate treatment between groups 6 months postfracture; secondary outcomes included differences in bone mineral density (BMD) testing and a predefined composite measure termed "appropriate care" (taking or making an informed decision to decline medication for those with low BMD; not taking bisphosphonate treatment for those with normal BMD). Absolute differences (%), relative risks (RR with 95% confidence intervals [CIs]), number-needed-to-treat (NNT), and direct costs were compared. A total of 181 participants were randomized to active-control and 180 to case-manager using computer-generated randomization; the groups were similar on study entry. At 6 months, 51 (28%) active-control versus 86 (48%) case-manager participants started bisphosphonate treatment (20% absolute difference; RR 1.70; 95% CI, 1.28 to 2.24; p < 0.0001; NNT = 5). Of active-controls, 108 (62%) underwent BMD testing compared to 128 (73%) case-managed patients (11% absolute difference; RR 1.17; 95% CI, 1.01 to 1.36; p = 0.03). Appropriate care was received by 76 (44%) active-controls and 133 (76%) case-managed participants (32% absolute difference; RR 1.73; 95% CI, 1.43 to 2.09; p < 0.0001). The direct cost per participant was $18 Canadian (CDN) for the active-control intervention compared to $66 CDN for the case-manager intervention. In summary, case-management led to substantially greater improvements in bisphosphonate treatment and appropriate care within 6 months of fracture than the active control. © 2018 American Society for Bone and Mineral Research.

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“…This specific subgroup might ask more actively for DXA screening due to their higher risk awareness. This might be a result of public campaigns successfully fostering awareness of osteoporosis among this specific subgroup, at least in high-income countries like Switzerland [ 28 ]. Unfortunately, most public campaigns fail to provide information on inappropriate DXA screening indications (e.g.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of bone density measurement in Switzerland: a cross-sectional study

et al. 2018

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BackgroundAccording to the WHO, osteoporosis is one of the most important non- communicable diseases worldwide. Different screening procedures are controversially discussed, especially concerning the concomitant issues of overdiagnosis and harm caused by inappropriate Dual X-ray Absorptiometry (DXA). The aim of this study was to evaluate the frequency and appropriateness of DXA as screening measure in Switzerland considering individual risk factors and to evaluate covariates independently associated with potentially inappropriate DXA screening.MethodsRetrospective cross-sectional study using insurance claim data of 2013. Among all patients with DXA screening, women < 65 and men < 70 years without osteoporosis or risk factors for osteoporosis were defined as receiving potentially inappropriate DXA. Statistics included descriptive measures and multivariable regressions to estimate associations of relevant covariates with potentially inappropriate DXA screening.ResultsOf 1,131,092 patients, 552,973 were eligible. Among those 2637 of 10,000 (26.4%) underwent potentially inappropriate DXA screening. Female sex (Odds ratio 6.47, CI 6.41–6.54) and higher age showed the strongest association with any DXA screening.Female gender (Odds ratio 1.84, CI 1.49–2.26) and an income among the highest 5% (Odds ratio 1.40, CI 1.01–1.98) were significantly positively associated with potentially inappropriate DXA screening, number of chronic conditions (Odds ratio 0.67, CI 0.65–0.70) and living in the central region of Switzerland (Odds ratio 0.67, CI 0.48–0.95) negatively.ConclusionOne out of four DXAs for screening purpose is potentially inappropriate. Stakeholders of osteoporosis screening campaigns should focus on providing more detailed information on appropriateness of DXA screening indications (e.g. age thresholds) in order to avoid DXA overuse.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5305-0) contains supplementary material, which is available to authorized users.

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Low self-awareness of osteoporosis and fracture risk among postmenopausal women

Abstract: These results show that postmenopausal women underestimate their risk of osteoporotic fractures when compared with their 10-year fracture risk according to FRAX algorithm.

Cited by 13 publications

References 20 publications

Self-perceived Fracture Risk in the Global Longitudinal Study of Osteoporosis in Women: Its Correlates and Relationship with Bone Microarchitecture

Self-perceived Fracture Risk in the Global Longitudinal Study of Osteoporosis in Women: Its Correlates and Relationship with Bone Microarchitecture

Comparing Strategies Targeting Osteoporosis to Prevent Fractures After an Upper Extremity Fracture (C-STOP Trial): A Randomized Controlled Trial

Appropriateness of bone density measurement in Switzerland: a cross-sectional study

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