Skip to main content
Top
Published in: Osteoporosis International 2/2007

01-02-2007 | Original Article

The importance of communication in secondary fragility fracture treatment and prevention

Authors: L. M. Meadows, L. A. Mrkonjic, M. D. O’Brien, W. Tink

Published in: Osteoporosis International | Issue 2/2007

Login to get access

Abstract

Introduction

We report on a Canadian longitudinal qualitative case study of midlife women with fragility fractures, their treating orthopaedic surgeons and family physicians.

Methods

Women and their treating physicians were followed for an average of one year post fracture to investigate the health outcomes and what, if any, follow-up occurred aimed at secondary fracture prevention. The final dataset includes 223 interviews gathered from women aged 40 to 65 with fragility fractures, orthopaedic surgeons and family physicians.

Results

The circle of care for those with fragility fractures is disrupted at vital communication junctures: (1) the inconsistent flow of information between acute care institutions and family physicians; (2) unidirectional and inconsistent communication from orthopaedic surgeons to family physicians; and (3) competing demands of the cast clinic environment and patient expectations. It is not the lack of will that is undermining the consistent and detailed communication among patients, physicians and institutions. It is the episodic nature of fracture care that makes communication among involved parties difficult, if not impossible.

Conclusions

Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures.
Literature
1.
go back to reference Klotzbuecher CM, Ross PD, Landsman PB, et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739PubMedCrossRef Klotzbuecher CM, Ross PD, Landsman PB, et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739PubMedCrossRef
2.
go back to reference Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(Suppl 10):S1–34 Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(Suppl 10):S1–34
3.
go back to reference McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003) The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14(12):1028–1034PubMedCrossRef McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003) The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14(12):1028–1034PubMedCrossRef
4.
go back to reference Meadows LM, Mrkonjic L (2003) Breaking-bad news: women’s experiences of fractures at midlife. Can J Public Health 94(6):427–430PubMed Meadows LM, Mrkonjic L (2003) Breaking-bad news: women’s experiences of fractures at midlife. Can J Public Health 94(6):427–430PubMed
5.
go back to reference Meadows LM, Mrkonjic L, Petersen KMA, Lagendyk L (2004) After the fall: women’s views of fractures in relation to bone health at midlife. Women Health 39(2):47–62PubMedCrossRef Meadows LM, Mrkonjic L, Petersen KMA, Lagendyk L (2004) After the fall: women’s views of fractures in relation to bone health at midlife. Women Health 39(2):47–62PubMedCrossRef
6.
go back to reference McLellan AR (2003) Identification and treatment of osteoporosis in fractures. Curr Rheumatol Rep 5(1):57–64PubMedCrossRef McLellan AR (2003) Identification and treatment of osteoporosis in fractures. Curr Rheumatol Rep 5(1):57–64PubMedCrossRef
7.
go back to reference van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13(8):624–629PubMedCrossRef van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13(8):624–629PubMedCrossRef
8.
9.
go back to reference Meadows LM, Mrkonjic L, Lagendyk L (2005) Women’s perceptions of future risk after low-energy fractures at midlife. Ann Fam Med 3(1):64–69PubMedCrossRef Meadows LM, Mrkonjic L, Lagendyk L (2005) Women’s perceptions of future risk after low-energy fractures at midlife. Ann Fam Med 3(1):64–69PubMedCrossRef
10.
go back to reference Cuddihy MT, Gabriel SE, Crowson CS, et al (2002) Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med 162(4):421–426PubMedCrossRef Cuddihy MT, Gabriel SE, Crowson CS, et al (2002) Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med 162(4):421–426PubMedCrossRef
11.
go back to reference Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163(7):819–822PubMed Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163(7):819–822PubMed
12.
go back to reference Papaioannou A, Giangregorio L, Kvern B, et al (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5(1):11PubMedCrossRef Papaioannou A, Giangregorio L, Kvern B, et al (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5(1):11PubMedCrossRef
13.
go back to reference Simonelli C, Chen YT, Morancey J, et al (2003) Evaluation and management of osteoporosis following hospitalization for low-impact fracture. J Gen Intern Med 18(1):17–22PubMedCrossRef Simonelli C, Chen YT, Morancey J, et al (2003) Evaluation and management of osteoporosis following hospitalization for low-impact fracture. J Gen Intern Med 18(1):17–22PubMedCrossRef
14.
go back to reference Siris ES, Bilezikian JP, Rubin MR, et al (2003) Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab 88(8):3482–3486PubMedCrossRef Siris ES, Bilezikian JP, Rubin MR, et al (2003) Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab 88(8):3482–3486PubMedCrossRef
15.
go back to reference Khan SA, de Geus C, Holroyd B, Russell AS (2001) Osteoporosis follow up after wrist fractures following minor trauma. Arch Intern Med 161(10):1309–1312PubMedCrossRef Khan SA, de Geus C, Holroyd B, Russell AS (2001) Osteoporosis follow up after wrist fractures following minor trauma. Arch Intern Med 161(10):1309–1312PubMedCrossRef
16.
go back to reference Tosi LL, Lane JM (1998) Osteoporosis prevention and the orthopaedic surgeon: when fracture care is not enough [editorial]. J Bone Joint Surg Am 80(11):1567–1569PubMed Tosi LL, Lane JM (1998) Osteoporosis prevention and the orthopaedic surgeon: when fracture care is not enough [editorial]. J Bone Joint Surg Am 80(11):1567–1569PubMed
17.
go back to reference Tosi LL (2000) Women and the orthopaedic surgeon: changing the relationship. Clin Orthop Relat Res 372:17–31PubMedCrossRef Tosi LL (2000) Women and the orthopaedic surgeon: changing the relationship. Clin Orthop Relat Res 372:17–31PubMedCrossRef
18.
go back to reference Dobbs Mb, Buckwalter J, Saltzman C (1999) Osteoporosis: the increasing role of the orthopaed. Iowa Orthop J 19:43–52PubMed Dobbs Mb, Buckwalter J, Saltzman C (1999) Osteoporosis: the increasing role of the orthopaed. Iowa Orthop J 19:43–52PubMed
19.
go back to reference Simonelli C, Killeen K, Mehle S, Swanson L (2002) Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc 77(4):334–338PubMedCrossRef Simonelli C, Killeen K, Mehle S, Swanson L (2002) Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc 77(4):334–338PubMedCrossRef
20.
go back to reference Skedros JG (2004) The orthopaedic surgeon’s role in diagnosing and treating patients with osteoporotic fractures: standing discharge orders may be the solution for timely medical care. Osteoporos Int 15(5):405–410PubMedCrossRef Skedros JG (2004) The orthopaedic surgeon’s role in diagnosing and treating patients with osteoporotic fractures: standing discharge orders may be the solution for timely medical care. Osteoporos Int 15(5):405–410PubMedCrossRef
21.
go back to reference Jagla S, McIsaac WJ, Hawker G, et al (2003) Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporosis Int 14:672–676PubMedCrossRef Jagla S, McIsaac WJ, Hawker G, et al (2003) Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporosis Int 14:672–676PubMedCrossRef
22.
go back to reference Jaglal SB, Carroll J, Hawker G, et al (2003) How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician 49:462–468PubMed Jaglal SB, Carroll J, Hawker G, et al (2003) How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician 49:462–468PubMed
23.
go back to reference Gallager TC, Geling O, Comite F (2002) Missed opportunities for prevention of osteoporotic fracture. Arch Intern Med 162(4):450–456CrossRef Gallager TC, Geling O, Comite F (2002) Missed opportunities for prevention of osteoporotic fracture. Arch Intern Med 162(4):450–456CrossRef
24.
go back to reference Freedman KB, Kaplan FS, Bilker WB, et al (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82–A(8):1063–1070PubMed Freedman KB, Kaplan FS, Bilker WB, et al (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82–A(8):1063–1070PubMed
25.
go back to reference Backett-Milburn K, Parry O, Mauthner N (2000) ‘I’ll worry about that when it comes along’: osteoporosis, a meaningful issue for women at mid-life? Health Educ Res 15(2):153–162PubMedCrossRef Backett-Milburn K, Parry O, Mauthner N (2000) ‘I’ll worry about that when it comes along’: osteoporosis, a meaningful issue for women at mid-life? Health Educ Res 15(2):153–162PubMedCrossRef
26.
go back to reference Ribeiro V, Blakeley J, Laryea M (2000) Women’s knowledge and practices regarding the prevention and treatment of osteoporosis. Health Care Women Int 21(4):347–353PubMedCrossRef Ribeiro V, Blakeley J, Laryea M (2000) Women’s knowledge and practices regarding the prevention and treatment of osteoporosis. Health Care Women Int 21(4):347–353PubMedCrossRef
27.
go back to reference Cuddihy MT, Amadio PC, Gabriel SE, et al (2004) A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture. Osteoporos Int 15(9):695–700PubMedCrossRef Cuddihy MT, Amadio PC, Gabriel SE, et al (2004) A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture. Osteoporos Int 15(9):695–700PubMedCrossRef
28.
go back to reference Papaioannou A, Parkinson W, Adachi J, et al (1998) Women’ decisions about hormone replacement therapy after education and bone densitometry. CMAJ 159(10):1253–1257PubMed Papaioannou A, Parkinson W, Adachi J, et al (1998) Women’ decisions about hormone replacement therapy after education and bone densitometry. CMAJ 159(10):1253–1257PubMed
29.
go back to reference Papaioannou A, Ioannidis G, Adachi JD, et al (2003) Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database. Osteoporos Int 14(10):808–813PubMedCrossRef Papaioannou A, Ioannidis G, Adachi JD, et al (2003) Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database. Osteoporos Int 14(10):808–813PubMedCrossRef
30.
go back to reference Yin RK (2003) Applications of Case Study Research, 2nd edn. Sage Publications, Thousand Oaks, CA Yin RK (2003) Applications of Case Study Research, 2nd edn. Sage Publications, Thousand Oaks, CA
31.
go back to reference Agar MH (1986) Speaking of Ethnography. Sage Publications, Newbury Park, CA Agar MH (1986) Speaking of Ethnography. Sage Publications, Newbury Park, CA
32.
go back to reference Creswell JW (1998) Qualitative Inquiry and Research Design: Choosing Among Five Traditions. Sage Publications, Thousand Oaks, CA Creswell JW (1998) Qualitative Inquiry and Research Design: Choosing Among Five Traditions. Sage Publications, Thousand Oaks, CA
33.
go back to reference Meadows LM, Verdi AJ, Crabtree BF (2003) Keeping up appearances: using qualitative research to enhance knowledge of dental practice. J Dent Educ 67(9):981–990PubMed Meadows LM, Verdi AJ, Crabtree BF (2003) Keeping up appearances: using qualitative research to enhance knowledge of dental practice. J Dent Educ 67(9):981–990PubMed
34.
go back to reference Strauss A, Corbin J (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage Publications, Newbury Park, CA Strauss A, Corbin J (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage Publications, Newbury Park, CA
35.
go back to reference Jennett PA (1995) Chart stimulated recall: a technique to assess clinical competence and performance. Educ Gen Practice 6:30–34 Jennett PA (1995) Chart stimulated recall: a technique to assess clinical competence and performance. Educ Gen Practice 6:30–34
36.
go back to reference Borkan JM (1999) Immersion / crystallization. In: BF Crabtree, WL Miller (eds) Doing Qualitative Research. Sage Publications, Thousand Oaks, CA, pp 179–194 Borkan JM (1999) Immersion / crystallization. In: BF Crabtree, WL Miller (eds) Doing Qualitative Research. Sage Publications, Thousand Oaks, CA, pp 179–194
37.
go back to reference Denzin NK (1989) Interpretive Interactionism. Sage Publications, Newbury Park, CA Denzin NK (1989) Interpretive Interactionism. Sage Publications, Newbury Park, CA
38.
go back to reference Crabtree BF, Miller WL (1999) The dance of interpretation. In: BF Crabtree, WL Miller (eds) Doing Qualitative Research. Sage Publications, Thousand Oaks, CA, pp 127–144 Crabtree BF, Miller WL (1999) The dance of interpretation. In: BF Crabtree, WL Miller (eds) Doing Qualitative Research. Sage Publications, Thousand Oaks, CA, pp 127–144
39.
go back to reference Meadows LM, Morse JM (2001) Constructing evidence within the qualitative project. In: JM Morse, JM Swanson, A Kuzel (eds) The Nature of Qualitative Evidence. Sage Publications, Thousand Oaks, CA, pp 187–200 Meadows LM, Morse JM (2001) Constructing evidence within the qualitative project. In: JM Morse, JM Swanson, A Kuzel (eds) The Nature of Qualitative Evidence. Sage Publications, Thousand Oaks, CA, pp 187–200
41.
go back to reference Crabtree BF, Miller WL, Tallia AF, et al (2005) Delivery of clinical preventive services in family medicine offices. Ann Fam Med 3(5):430–435PubMedCrossRef Crabtree BF, Miller WL, Tallia AF, et al (2005) Delivery of clinical preventive services in family medicine offices. Ann Fam Med 3(5):430–435PubMedCrossRef
Metadata
Title
The importance of communication in secondary fragility fracture treatment and prevention
Authors
L. M. Meadows
L. A. Mrkonjic
M. D. O’Brien
W. Tink
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 2/2007
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-006-0213-z

Other articles of this Issue 2/2007

Osteoporosis International 2/2007 Go to the issue