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Sale J.E.M.,Li Ka Shing Knowledge Institute | Sale J.E.M.,University of Toronto | Gignac M.A.,University of Western Ontario | Gignac M.A.,University of Toronto | And 8 more authors.
Osteoporosis International | Year: 2012

Summary: We examined patients' communication about fragility fractures to gain insight into why patients do not connect fractures to bone health. The term "fragility" fracture was a misnomer to patients who perceived the event as physically and emotionally traumatic. Improved communication about such fractures could facilitate awareness of bone health. Introduction: We examined patients' communication about fragility fractures to gain insight into why patients do not perceive the connection between their fracture and low bone mass. Methods: A descriptive phenomenological (qualitative) study was conducted. During face-to-face interviews, the participants described the experience of their fracture in detail and the circumstances surrounding the fracture. Data analysis was guided by Giorgi's methodology. English-speaking male and female patients aged 65+ years and "high" risk for future fracture were eligible and screened for osteoporosis through an established screening program at an urban teaching hospital. Results: We recruited 30 participants (9 males, 21 females), aged 65-88, who presented with a hip (n=11), wrist (n = 11), shoulder (n=6), or other (n=2) fracture. Ten of the 30 fractures occurred inside the home and the remaining fractures occurred outside the home. Sustaining a fragility fracture was perceived as a traumatic event, both physically and emotionally. In general, participants used forceful, actionoriented words and referred to hard surfaces to describe the experience. Explanations for the fracture, other than bone quality, were often reported, especially that falls were "freak" or "fluke" events. Patients who sustained a fracture under more mundane circumstances seemed more likely to perceive a connection between the fracture and their bone health. Conclusions: The term fragility fracture was a misnomer for many older adults. By reexamining how this term is communicated to fracture patients, health care providers may better facilitate patients' awareness of bone health. © International Osteoporosis Foundation and National Osteoporosis Foundation 2012. Source


Sale J.E.M.,Li Ka Shing Knowledge Institute | Sale J.E.M.,University of Toronto | Bogoch E.,Mobility Program | Bogoch E.,University of Toronto | And 8 more authors.
Osteoporosis International | Year: 2014

Summary: We examined patients’ experiences regarding bone mineral density (BMD) testing and bone health treatment after being screened through Ontario’s Fracture Clinic Screening Program. Provider-level barriers to testing and treatment appeared to be as significant as patient-level barriers and potentially had more of an impact on treatment than on testing.Introduction: Post-fracture secondary prevention programs have had modest effects on bone densitometry rates and osteoporosis (OP) treatment initiation. Few studies have examined in depth the reasons that patients choose to seek or avoid investigation and treatment after screening through such a program. Our purpose was to examine patients’ experiences regarding bone mineral density (BMD) testing and bone health treatment after screening through Ontario’s Fracture Clinic Screening Program (FCSP).Methods: We conducted a prospective qualitative study in fragility fracture patients screened through one site of the FCSP. Eligible patients not on antiresorptive medication at the time of fracture were assessed by an osteoporosis screening coordinator and advised to follow up with their primary care physician for a BMD test and appropriate treatment. Participants were interviewed within 6, and within 18, months of their clinic visit. Fracture risk was assessed by the study team. Interviews were transcribed verbatim and analyzed by two researchers.Results: We conducted 51 interviews with 25 patients (22 females, 3 males) aged 50–79 years old, of whom 8 were deemed high risk for future fracture. Eighteen participants had a BMD test between baseline and follow-up and three reported receiving a prescription for pharmacotherapy. We categorized 21 participants as experiencing at least one barrier to BMD testing and appropriate treatment including health care providers telling participants that the fracture was not a fragility fracture, using participants’ appearance/demographic information and X-rays to judge bone density, telling participants that a BMD test was not appropriate, failing to discuss fracture risk status, and giving unclear or incorrect information about treatment.Conclusion: We identified modifiable barriers to post-fracture secondary prevention from the patient’s perspective. Provider-level barriers appeare to be as significant as patient-level barriers and potentially had more of an impact on treatment than on BMD testing. © 2014, International Osteoporosis Foundation and National Osteoporosis Foundation. Source


Sale J.E.M.,Li Ka Shing Knowledge Institute | Sale J.E.M.,University of Toronto | Gignac M.A.,Institute for Work and Health | Gignac M.A.,University of Toronto | And 8 more authors.
Osteoporosis International | Year: 2016

Summary: We examined fracture patients’ understanding of “high” fracture risk after they were screened through a post-fracture secondary prevention program and educated about their risk verbally, numerically, and graphically. Our findings suggest that messages about fracture risk are confusing to patients and need to be modified to better suit patients’ needs. Introduction: The aim of this study was to examine fracture patients’ understanding of high risk for future fracture. Methods: We conducted an in-depth qualitative study in patients who were high risk for future fracture. Patients were screened through the Osteoporosis Exemplary Care Program where they were educated about fracture risk: verbally told they were “high risk” for future fracture, given a numerical prompt that they had a >20 % chance of future fracture over the next 10 years, and given a visual graph highlighting the “high risk” segment. This information about fracture risk was also relayed to patients’ primary care physicians (PCPs) and specialists. Participants were interviewed at baseline (within six months of fracture) and follow-up (after visit with a PCP and/or specialist) and asked to recall their understanding of risk and whether it applied to them. Results: We recruited 27 patients (20 females, 7 males) aged 51–87 years old. Fractures were sustained at the wrist (n = 7), hip (n = 7), vertebrae (n = 2), and multiple or other locations (n = 11). While most participants recalled they had been labeled as “high risk” (verbal cue), most were unable to correctly recall the other elements of risk (numerical, graphical). Further, approximately half of the patients who recalled they were high risk did not believe that high risk applied, or had meaning, to them. Participants also had difficulty explaining what they were at risk for. Conclusions: Our results suggest that health care providers’ messages about fracture risk are confusing to patients and that these messages need to be modified to better suit patients’ needs. © 2015, International Osteoporosis Foundation and National Osteoporosis Foundation. Source


Sale J.E.M.,Li Ka Shing Knowledge Institute | Sale J.E.M.,University of Toronto | Gignac M.A.,University of Western Ontario | Gignac M.A.,University of Toronto | And 8 more authors.
BMC Musculoskeletal Disorders | Year: 2011

Background: Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture. Methods. A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology. Results: 21 patients (6 males, 15 females) aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication). These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication). These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date. Conclusions: Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care providers should be aware of their potential role in patients' decisions and monitor patients' decisions over time. © 2011 Sale et al; licensee BioMed Central Ltd. Source


Hamilton C.J.,Osteoporosis Research Program | Hamilton C.J.,University of Toronto | Swan V.J.D.,Osteoporosis Research Program | Jamal S.A.,Osteoporosis Research Program | Jamal S.A.,University of Toronto
Osteoporosis International | Year: 2010

The cumulative risk of fracture for a postmenopausal woman over the age of 50 can reach up to 60%. Exercise has the potential to modify fracture risk in postmenopausal women through its effects on bone mass and geometry; however, these effects are not well characterized. To determine the effects of exercise on bone mass and geometry in postmenopausal women, we conducted a systematic review of the literature. We included all randomized controlled trials, cross-sectional studies, and prospective studies that used peripheral quantitative computed tomography to assess the effects of exercise on bone mass and geometry in this population. Exercise effects appear to be modest, site-specific, and preferentially influence cortical rather than trabecular components of bone. Exercise type also plays a role, with the most prominent mass and geometric changes being observed in response to high-impact loading exercise. Exercise appears to positively influence bone mass and geometry in postmenopausal women. However, further research is needed to determine the types and amounts of exercise that are necessary to optimize improvements in bone mass and geometry in postmenopausal women and determine whether or not these improvements are capable of preventing fractures. © 2009 International Osteoporosis Foundation and National Osteoporosis Foundation. Source

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