Prevention of Osteoporotic Fractures in Residential Aged Care: Updated Consensus Recommendations

Duque, Gustavo; Iuliano, Sandra; Close, Jacqueline C.T.; Fatima, Mizhgan; Ganda, Kirtan; Bird, Stefanie; Kirk, Ben; Levidiotis, M; Said, Catherine M; Παπαϊωάννου, Αλεξάνδρα; Inderjeeth, Charles

doi:10.1016/j.jamda.2021.12.041

Cited by 8 publications

(25 citation statements)

References 42 publications

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“…However, with physicians responsible for the commencement of osteoporosis therapy there is a need for their involvement to increase this aspect of osteoporosis management. It is widely documented that physicians place a low level of priority on osteoporosis management and perceive several barriers to therapy commencement [5,6,9,46]. Physician barriers to osteoporosis therapy commencement include a mix of clinical and systemic factors, such as uncertainty regarding therapy effectiveness [6,9], potential adverse effects [6,9,46], contributing to polypharmacy [5,9,46], time requirements for case finding [5] and uncertainty regarding the clinical responsibility of osteoporosis management [5].…”

Section: Discussionmentioning

confidence: 99%

“…It is widely documented that physicians place a low level of priority on osteoporosis management and perceive several barriers to therapy commencement [5,6,9,46]. Physician barriers to osteoporosis therapy commencement include a mix of clinical and systemic factors, such as uncertainty regarding therapy effectiveness [6,9], potential adverse effects [6,9,46], contributing to polypharmacy [5,9,46], time requirements for case finding [5] and uncertainty regarding the clinical responsibility of osteoporosis management [5]. In the interventions, pharmacists addressed these issues by identifying patients for investigation and treatment and assisting the physicians to apply treatment guidelines to these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Osteoporosis management guidelines recommend the performance of fracture risk assessment to guide BMD testing and treatment commencement [4,[46][47][48]. A systematic review undertaken by Merlijn et al (2020) found population screening for individuals at high risk of fracture is an effective strategy for increasing treatment rates and reducing fracture rates [49].…”

Section: Discussionmentioning

confidence: 99%

“…However, quality appraisal identified methodological concerns which may have led to the undermining of this study's outcomes and hence impact the conclusions that can be drawn. From other literature, pharmacists undertaking medication reviews have the potential to improve osteoporosis management [8,46,48,[51][52][53]. Specifically, medication review is advocated in multiple international guidelines for reducing falls and subsequent fractures, as well as aiding in the identification and management of those at risk of drug-induced secondary osteoporosis [46,48,[51][52][53].…”

Section: Discussionmentioning

confidence: 99%

“…From other literature, pharmacists undertaking medication reviews have the potential to improve osteoporosis management [8,46,48,[51][52][53]. Specifically, medication review is advocated in multiple international guidelines for reducing falls and subsequent fractures, as well as aiding in the identification and management of those at risk of drug-induced secondary osteoporosis [46,48,[51][52][53]. As medication review is an established pharmacist intervention, accepted by physicians [42,50], the potential for it being used as a framework for incorporating physician collaboration into a pharmacist osteoporosis intervention could have merit.…”

Section: Discussionmentioning

confidence: 99%

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Pharmacist interventions in osteoporosis management: a systematic review

2022

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Internationally, there is an osteoporosis treatment gap, which pharmacists may assist in closing. This review identifies pharmacist interventions for improving osteoporosis management and evaluates their effectiveness. Pharmacist interventions are shown to improve osteoporosis management in terms of increasing investigation and treatment commencement and osteoporosis therapy adherence. Introduction This review identifies pharmacist interventions for improving osteoporosis management and evaluates their effectiveness. Methods A literature search using PubMed, Embase, International Pharmaceutical Abstracts, and Cumulative Index to Nursing and Allied Health Literature was undertaken from database inception to June 2022. Randomised controlled trials were eligible, if they included adults diagnosed with or at risk of osteoporosis and assessed pharmacist interventions to improve osteoporosis management. Outcomes regarding investigation, treatment, adherence and patient knowledge were evaluated using qualitative analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme checklists and the Cochrane Collaboration tool to assess the risk of bias (Rob 2.0). Results Sixteen articles (12 different studies) with a total of 16,307 participants, published between 2005 and 2018 were included. Pharmacist interventions were classified into two categories, those targeting investigation and treatment (n = 10) and those targeting adherence (n = 2). The impact of the intervention on patient knowledge was considered by studies targeting both investigation and treatment (n = 2) and adherence (n = 1). Pharmacist interventions demonstrated benefit for all outcomes; however, the extent to which conclusions can be drawn on their effectiveness is limited by the heterogeneity of interventions employed and methodological issues identified. Patient education and counselling were identified as a cornerstone of pharmacist interventions targeting both investigation and treatment and adherence, along with the importance of pharmacist and physician collaboration. Conclusion Pharmacist interventions show promise for improving osteoporosis management. The potential for pharmacists to contribute to closing the osteoporosis treatment gap through undertaking population screening has been identified.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pharmacist interventions in osteoporosis management: a systematic review

2022

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Perceptions and practices of aged care pharmacists regarding osteoporosis management: a qualitative study

2023

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Background Osteoporosis is a common but sub-optimally managed disease among aged care residents. Although pharmacists are one of the key healthcare providers responsible for osteoporosis medication management there is limited research on their involvement. Aim This study explored the perceptions and practices of Australian pharmacists regarding osteoporosis management for aged care residents. Method Semi-structured interviews were conducted with aged care pharmacists. Interviews were recorded, transcribed, and analysed using a constructivist grounded theory approach. Results Twenty-one aged care pharmacists were interviewed. Three main themes were identified: osteoporosis is highly prevalent but given low priority, factors affecting pharmacists’ management of osteoporosis, and optimism for the future role of pharmacists in osteoporosis management. The complexity of aged care residents’ healthcare needs and the silent, insidious nature of osteoporosis contribute to the low priority it is afforded. Barriers identified by pharmacists included their current practice model, limited access to residents’ medical histories and difficulties accessing bone mineral density (BMD) testing. Interdisciplinary collaboration and education regarding osteoporosis management were seen as facilitators. Pharmacists were optimistic that an embedded practice model would improve their capacity to influence osteoporosis management. Conclusion The high prevalence and low priority of osteoporosis in the aged care setting presents pharmacists with an opportunity to improve medication management and reduce fracture risk. Barriers to osteoporosis management identified by pharmacists can be addressed by interdisciplinary collaboration and education. Pharmacists being embedded in aged care could enable more opportunities to contribute to the interdisciplinary team and become champions of osteoporosis management.

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