Secondary contributors to bone loss in osteoporosis related hip fractures

Edwards, Beatrice J.; Langman, Craig B.; Bunta, Andrew D.; Vicuña, María Nabal; Favus, Murray J.

doi:10.1007/s00198-007-0525-7

Cited by 58 publications

(44 citation statements)

References 66 publications

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“…Uncertainty about the cut-points was presented in only four of 92 visits (4.3 %). One [18][19][20][21][22][23][24] -There is inadequate evidence linking vitamin D to health outcomes such as immune disease, cardiovascular disease, cancer risk, quality of life 15 Presenting benefits of vitamin D that are not fully substantiated in the literature Certain statements BThe thing about vitamin D that's so amazing is…it works on cancer. It works on heart disease.…”

Section: Comparison Of Provider Discussion and Scientific Evidence mentioning

confidence: 99%

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D

2016

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BACKGROUND:Little is known about how providers communicate recommendations when scientific uncertainty exists. OBJECTIVES: To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated. DESIGN: Qualitative (inductive systematic content analysis) and quantitative analysis of previously collected audio-recorded provider-patient office visits. PARTICIPANTS: Sixty-one providers and a socioeconomically diverse convenience sample of 603 of their patients from outpatient community-and academicbased primary care, integrative medicine, and complementary and alternative medicine provider offices in Southern California. MAIN MEASURES:Comparison of provider informationgiving about vitamin D to professional guidelines and scientific information for which conflicting recommendations or insufficient scientific evidence exists; certainty with which information was conveyed. RESULTS: Ninety-two (15.3 %) of 603 visit discussions touched upon issues related to vitamin D testing, management and benefits. Vitamin D deficiency screening was discussed with 23 (25 %) patients, the definition of vitamin D deficiency with 21 (22.8 %), the optimal range for vitamin D levels with 26 (28.3 %), vitamin D supplementation dosing with 50 (54.3 %), and benefits of supplementation with 46 (50 %). For each of the professional guidelines/scientific information examined, providers conveyed information that deviated from professional guidelines and the existing scientific evidence. Of 166 statements made about vitamin D in this study, providers conveyed 160 (96.4 %) with certainty, without mention of any equivocal or contradictory evidence in the scientific literature. No uncertainty was mentioned when vitamin D dosing was discussed, even when recommended dosing was higher than guideline recommendations. CONCLUSIONS AND RELEVANCE: Providers convey the vast majority of information and recommendations about vitamin D with certainty, even though the scientific literature contains inconsistent recommendations and declarations of inadequate evidence. Not communicating uncertainty blurs the contrast between evidence-based recommendations and those without evidence. Providers should explore best practices for involving patients in decision-making by acknowledging the uncertainty behind their recommendations. INTRODUCTIONMedical care is full of uncertainty. Uncertainty is inherent in most diagnostic and treatment decisions.1,2 Decision-making is complicated by equivocal, insufficient or nonexistent scientific evidence, and by differences in provider or patient interpretations of the evidence. Medical communication guidelines suggest disclosing uncertainty to patients.3,4 Yet providers typically fail to convey uncertainty, 5 and the scientific literature contains little information about provider recommendations in the context of uncertainty.Vitamin D supplementation is a good topic for investigating provider-patient communication around scientific uncertainty, because 26-56 % of Americans tak...

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Section: Comparison Of Provider Discussion and Scientific Evidence mentioning

confidence: 99%

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D

2016

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“…Secondary causes for bone loss are remarkably common in patients with hip fractures, as Edwards et al [17] found more than 80% of patients with hip fractures had an unrecognized cause for bone loss, with vitamin D deficiency being most common. Osteoporosis in men is more likely to be a marker of a systemic disease.…”

Section: Pathophysiology Of Osteoporosismentioning

confidence: 99%

Sex and Gender Considerations in Male Patients With Osteoporosis

LaMont

Ton

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Osteoporosis remains underrecognized and undertreated in both men and women, but men who sustain fragility fractures experience greater morbidity and mortality. While men exhibit advanced comorbidity at the time of hip fracture presentation, there are distinct sex-and gender-specific factors related to the pathophysiology and treatment of osteoporosis that further influence morbidity and mortality. Questions/purposes With a selective review of the literature, we evaluated sex-and gender-based differences contributing to increased morbidity and mortality in men with osteoporosis.

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“…4 Results from other published studies on fractures in MGUS patients [5][6][7][8] have shown 1.4-to 6.3-fold increased risk of fractures in MGUS patients. Researchers have found a high prevalence of MGUS in osteoporotic patients, [9][10][11][12] which has led some authors to suggest that protein electrophoresis should always be performed as screening for MGUS (and MM) in patients with osteoporosis and/or fractures. 9,10,13 However, these studies have been limited by lack of control population, and the scientific rationale for these recommendations is scarce.…”

Section: Introductionmentioning

confidence: 99%