Patient Perceptions of the Path to Osteoporosis Care Following a Fragility Fracture

Abstract

Coordinator-based osteoporosis (OP) screening programs for fragility-fracture patients in orthopedic environments improve rates of OP testing and care, but there are still gaps in care. The purpose of this study was to understand the process by which patients decided whether to proceed with OP testing or care within these programs. Twenty-four fragility-fracture patients in the OP screening program at a large, urban, university hospital in Canada participated in one of five focus groups. Focus group transcripts were sorted and coded. Links between themes were developed to generate a description of the process leading to successful initiation of OP care after a fragility fracture. To initiate OP testing and care, patients had to both comprehend the link between their fragility fracture and OP, and make an action-oriented appraisal of what action to take. Several modifiable facilitators and barriers influenced the process between screening and undergoing OP testing and initiating treatment.

Concern and Risk Perception: Effects on Osteoprotective Behaviour

“…Linking osteoporosis firmly to risk of fractures should also be the focus of future osteoporosis education programs as it was only risk perception to fractures and not risk perceptions to osteoporosis that was associated with osteoporosis pharmacologic therapy. Appreciating the link between osteoporosis and fractures is vital and has been described previously by Beaton et al as the “aha” moment that provides the impetus for patients to move towards positive bone-protective actions such as BMD testing and AOM, if required [40]. …”

Establishing a Fracture Liaison Service: An Orthopaedic Approach

“…There are several reasons for this: (1) the orthopaedic surgeon is already engaged with the patient and family through fracture treatment and is the one who demonstrates a link between the fracture and fracturerelated disease state; (2) patients often do not return to their primary physician until after a fracture has healed, leading to the misconception that no further intervention is required; and (3) office visit time limitations of the primary care physician due to required management of other medical comorbidities may lead to a lack of prioritization of osteoporosis management and gaps in postfracture treatment 11,[54][55][56][57][58][59] .…”

Evaluation of a Nationwide Pharmacist-Led Phone Outreach Program to Improve Osteoporosis Management in Older Women with Recently Sustained Fractures

“…Patients more open to preventative management may have already initiated appropriate prophylactic therapy, leaving behind those less likely to initiate some patients receive appropriate osteoporosis management and not others. 16 Patients alone must complete a series of steps and encounter many barriers in order to receive appropriate treatment. The study pointed out a subgroup of patients who more directly received appropriate care by simply trusting and following their physicians' recommendations.…”