Abstract
BackgroundThe majority of frail elderly who live in long-term care (LTC) are not treated for osteoporosis despite their high risk for fragility fractures. Clinical Practice Guidelines for the diagnosis and management of osteoporosis provide guidance for the management of individuals 50 years and older at risk for fractures, however, they cannot benefit LTC residents if physicians perceive barriers to their application. Our objectives are to explore current practices to fracture risk assessment by LTC physicians and describe barriers to applying the recently published Osteoporosis Canada practice guidelines for fracture assessment and prevention in LTC.MethodsA cross-sectional survey was conducted with the Ontario Long-Term Care Physicians Association using an online questionnaire. The survey included questions that addressed members’ attitudes, knowledge, and behaviour with respect to fracture risk assessment in LTC. Closed-ended responses were analyzed using descriptive statistics and thematic framework analysis for open-ended responses.ResultsWe contacted 347 LTC physicians; 25% submitted completed surveys (81% men, mean age 60 (Standard Deviation [SD] 11) years, average 32 [SD 11] years in practice). Of the surveyed physicians, 87% considered prevention of fragility fractures to be important, but a minority (34%) reported using validated fracture risk assessment tools, while 33% did not use any. Clinical risk factors recommended by the OC guidelines for assessing fracture risk considered applicable included; glucocorticoid use (99%), fall history (93%), age (92%), and fracture history (91%). Recommended clinical measurements considered applicable included: weight (84%), thyroid-stimulating hormone (78%) and creatinine (73%) measurements, height (61%), and Get-Up-and-Go test (60%). Perceived barriers to assessing fracture risk included difficulty acquiring necessary information, lack of access to tests (bone mineral density, x-rays) or obtaining medical history; resource constraints, and a sentiment that assessing fracture risk is futile in this population because of short life expectancy and polypharmacy.ConclusionPerceived barriers to fracture risk assessment and osteoporosis management in LTC have not changed recently, contributing in part to the ongoing care gap in osteoporosis management. Our findings highlight the importance to adapt guidelines to be applicable to the LTC environment, and to develop partnerships with stakeholders to facilitate their use in clinical practice.
Highlights
Risk factors considered to be important on history and pertinent to document in the long-term care (LTC) setting included: glucocorticoid use, fall history, age, and the presence of previous fragility fractures
bone mineral density (BMD) measurement and spine radiographs were felt to be applicable in the LTC setting by approximately 55% of participants; the use of the validated fracture prediction tools FRAX and CAROC, as recommended by the Osteoporosis Canada (OC) guidelines were deemed applicable by less than 40%
Because of perceived barriers associated with using FRAX or CAROC, many LTC physicians may be adapting their own strategies for fracture risk assessment in LTC leading to suboptimal bone health management
Summary
The guidelines strongly recommend the use of the validated fracture risk assessment tools FRAX or CAROC (Canadian Association of Radiologists and Osteoporosis Canada). These tools evaluate the risk of osteoporosis-related fractures based on individual risk factors and are appropriate for use in clinical practice [8]. Both tools are country- and sex- specific, and based on sets of risk factors that include age, BMD of the hip (FRAX, but not CAROC, can provide a score in the absence of BMD measurement), prevalent fragility fractures, use of glucocorticoids and others, and predict the 10-year probability of major osteoporotic fractures (hip, spine, distal forearm and humerus). Attention must be devoted to adapt this knowledge to the context and its stakeholders [10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
