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Low acceptance of treatment in the elderly for the secondary prevention of osteoporotic fracture in the acute rehabilitation setting

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Abstract

Background and aims: Given the high risk of subsequent fracture among elderly persons with fracture, it is important to initiate secondary treatment for osteoporosis. Acute rehabilitation centers may offer a unique opportunity to introduce treatment. Therefore, we evaluated willingness-to-participate and compliance with evidence-based interventions for the secondary prevention of osteoporotic fracture in a non-randomized study conducted in the acute rehabilitation setting. We also described differences in baseline characteristics between study participants and non-participants. Methods: All consecutive, community-dwelling admissions to an acute rehabilitation unit (Boston, MA) with the diagnosis of fracture were screened for enrollment. Eligible subjects were offered a free, 6-month supply of alendronate/cholecalciferol (70 mg/2800 IU weekly), calcium and vitamin D supplements, and fall prevention strategies. Six-month compliance (≥75% consumption of medication or supplement) with the interventions was determined at a home visit. Results: Among 62 eligible subjects, 25 agreed to participate. Non-participants were older than participants (86 vs 80 yrs, p<0.01). There was no significant difference between other characteristics of participants and non-participants including sex, weight, type of fracture, cognitive status, and functional status. The most common reason for non-participation was reluctance to take another medication. Among participants, only 52% were compliant with alendronate and 58% were compliant with calcium and vitamin D supplementation at 6 months. Conclusions: Willingness-to-participate and compliance with secondary prevention strategies for osteoporosis was low in the acute rehabilitation setting, even when medications were provided free of cost. Educating individuals with fracture and their families on the consequences and treatment of osteoporosis may help to decrease the risk of sustaining a second fracture by accepting secondary preventive measures.

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References

  1. McKinley ED, Thompson JW, Briefer-French J, Wilcox LS, Weisman CS, Andrews WC. Performance indicators in women’s health: incorporating women’s health in the health plan employer data and information set (HEDIS). Womens Health Issues 2002; 12: 46–58.

    Article  PubMed  Google Scholar 

  2. Physician’s Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation, Washington D.C., 2008.

  3. Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T. Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med 2003; 163: 2165–72.

    Article  PubMed  Google Scholar 

  4. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000; 15: 721–39.

    Article  CAS  PubMed  Google Scholar 

  5. Berry SD, Samelson EJ, Hannan MT et al. Second hip fracture in older men and women: the Framingham Study. Arch Intern Med 2007; 167: 1971–6.

    Article  PubMed  Google Scholar 

  6. Nguyen-Oghalai TU, Kuo YF, Zhang DD, Graham JE, Goodwin JS, Ottenbacher KJ. Discharge setting for patients with hip fracture: trends from 2001 to 2005. J Am Geriatr Soc 2008; 56: 1063–8.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003; (4): CD000340.

  8. Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 1996; 77: 1226–32.

    Article  CAS  PubMed  Google Scholar 

  9. Nymark T, Lauritsen JM, Ovesen O, Rock ND, Jeune B. Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study. Osteoporos Int 2006; 17: 1353–7.

    Article  CAS  PubMed  Google Scholar 

  10. Fraenkel L, Gulanski B, Wittink D. Patient treatment preferences for osteoporosis. Arthritis Rheum 2006; 55: 729–35.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Hadji P, Minne H, Pfeifer M et al. Treatment preference for monthly oral ibandronate and weekly oral alendronate in women with postmenopausal osteoporosis: A randomized, crossover study (BALTO II). Joint Bone Spine 2008; 75: 303–10.

    Article  CAS  PubMed  Google Scholar 

  12. Lyles KW, Colon-Emeric CS, Magaziner JS et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357: nihpa40967.

  13. Wells G, Cranney A, Peterson J et al. Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008: D004523.

  14. Wells GA, Cranney A, Peterson J et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008: CD001155.

  15. Giangregorio L, Papaioannou A, Thabane L et al. Do patients perceive a link between a fragility fracture and osteoporosis? BMC Musculoskelet Disord 2008; 9: 38.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Mauck KF, Cuddihy MT, Trousdale RT, Pond GR, Pankratz VS, Melton LJ 3rd. The decision to accept treatment for osteoporosis following hip fracture: exploring the woman’s perspective using a stage-of-change model. Osteoporos Int 2002; 13: 560–4.

    Article  CAS  PubMed  Google Scholar 

  17. Yood RA, Mazor KM, Andrade SE, Emani S, Chan W, Kahler KH. Patient decision to initiate therapy for osteoporosis: the influence of knowledge and beliefs. J Gen Intern Med 2008; 23: 1815–21.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Forkan R, Pumper B, Smyth N, Wirkkala H, Ciol MA, Shumway-Cook A. Exercise adherence following physical therapy intervention in older adults with impaired balance. Phys Ther 2006; 86: 401–10.

    PubMed  Google Scholar 

  19. Gardner MJ, Brophy RH, Demetrakopoulos D et al. Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. J Bone Joint Surg Am 2005; 87: 3–7.

    Article  PubMed  Google Scholar 

  20. Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 2007; 297: 387–94.

    Article  CAS  PubMed  Google Scholar 

  21. Feldstein AC, Schneider J, Smith DH et al. Harnessing stakeholder perspectives to improve the care of osteoporosis after a fracture. Osteoporos Int 2008; 19: 1527–40.

    Article  CAS  PubMed  Google Scholar 

  22. Perreault S, Dragomir A, Desgagne A et al. Trends and determinants of antiresorptive drug use for osteoporosis among elderly women. Pharmacoepidemiol Drug Saf 2005; 14: 685–95.

    Article  CAS  PubMed  Google Scholar 

  23. Curtis JR, Xi J, Westfall AO et al. Improving the prediction of medication compliance: the example of bisphosphonates for osteoporosis. Med Care 2009; 47: 334–41.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA

    Sarah D. Berry MD, MPH, Devyani Misra, Marian T. Hannan & Douglas P. Kiel

  2. Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Sarah D. Berry MD, MPH, Devyani Misra, Marian T. Hannan & Douglas P. Kiel

Authors
  1. Sarah D. Berry MD, MPH
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  2. Devyani Misra
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  3. Marian T. Hannan
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  4. Douglas P. Kiel
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Correspondence to Sarah D. Berry MD, MPH.

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Berry, S.D., Misra, D., Hannan, M.T. et al. Low acceptance of treatment in the elderly for the secondary prevention of osteoporotic fracture in the acute rehabilitation setting. Aging Clin Exp Res 22, 231–237 (2010). https://doi.org/10.1007/BF03324801

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  • DOI: https://doi.org/10.1007/BF03324801

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