Bone Quality: Educational Tools for Patients, Physicians, and Educators
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Defining bone quality remains elusive. From a patient perspective bone quality can best be defined as an individual’s likelihood of sustaining a fracture. Fracture risk indicators and performance measures can help clinicians better understand individual fracture risk. Educational resources such as the Web can help clinicians and patients better understand fracture risk, communicate effectively, and make decisions concerning diagnosis and treatment.
We examined four questions: What tools can be used to identify individuals at high risk for fracture? What clinical performance measures are available? What strategies can help ensure that patients at risk for fracture are identified? What are some authoritative Web sites for educating providers and patients about bone quality?
Using Google, PUBMED, and trademark names, we reviewed the literature using the terms “bone quality” and “osteoporosis education.” Web site legitimacy was evaluated using specific criteria. Educational Web sites were limited to English-language sites sponsored by nonprofit organizations
The Fracture Risk Assessment Tool® (FRAX®) and the Fracture Risk Calculator (FRC) are reliable means of assessing fracture risk. Performance measures relating to bone health were developed by the AMA convened Physician Consortium for Performance Improvement® and are included in the Physician Quality Reporting Initiative. In addition, quality measures have been developed by the Joint Commission. Strategies for identifying individuals at risk include designating responsibility for case finding and intervention, evaluating secondary causes of osteoporosis, educating patients and providers, performing cost-effectiveness evaluation, and using information technology. An abundance of authoritative educational Web sites exists for providers and patients.
Effective clinical indicators, performance measures, and educational tools to better understand and identify fracture risk are now available. The next challenge is to encourage broader use of these resources so that individuals at high risk for fracture will not just be identified but will also adhere to therapy.
- American Society for Bone and Mineral Research. National Action Plan for Bone Health. Available at: http://www.asbmr.org/Advocacy/NAP.aspx. Accessed March 7, 2011.
- Barr, RJ, Stewart, A, Torgerson, DJ, Reid, DM (2010) Population screening for osteoporosis risk: a randomised control trial of medication use and fracture risk. Osteoporos Int. 21: pp. 561-568 CrossRef
- Bliuc, D, Eisman, JA, Center, JR (2006) A randomized study of two different information based interventions on the management of osteoporosis in minimal and moderate trauma fractures. Osteoporos Int. 17: pp. 1309-1317 CrossRef
- Bogoch, ER, Elliot-Gibson, V, Beaton, DE, Jamal, SA, Josse, RG, Murray, TM (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am. 88: pp. 25-34 CrossRef
- Boyd, CM, Darer, J, Boult, C, Fried, LP, Boult, L, Wu, AW (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 294: pp. 716-724 CrossRef
- Brauer, CA, Coca-Perraillon, M, Cutler, DM, Rosen, AB (2009) Incidence and mortality of hip fractures in the United States. JAMA. 302: pp. 1573-1579 CrossRef
- Burge, R, Dawson-Hughes, B, Solomon, DH, Wong, JB, King, A, Tosteson, A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 22: pp. 465-475 CrossRef
- Centers for Medicaid and Medicare Services. Physician Quality Reporting Initiative. Available at: www.cms.hhs.gov/pqri/. Accessed March 7, 2011.
- Cohen, K, Maier, D (2008) Osteoporosis: evaluation of screening patterns in a primary-care group practice. J Clin Densitom. 11: pp. 498-502 CrossRef
- Cooper, C (1993) The epidemiology of fragility fractures: is there a role for bone quality?. Calcif Tissue Int 53: pp. S23-S26 CrossRef
- Cranney, A, Lam, M, Ruhland, L, Brison, R, Godwin, M, Harrison, MM, Harrison, MB, Anastassiades, T, Grimshaw, JM, Graham, ID (2008) A multifaceted intervention to improve treatment of osteoporosis in postmenopausal women with wrist fractures: a cluster randomized trial. Osteoporos Int. 19: pp. 1733-1740 CrossRef
- Curtis, JR, Carbone, L, Cheng, H, Hayes, B, Laster, A, Matthews, R, Saag, KG, Sepanski, R, Tanner, SB, Delzell, E (2008) Longitudinal trends in use of bone mass measurement among older Americans, 1999–2005. J Bone Miner Res. 23: pp. 1061-1067 CrossRef
- Dawson-Hughes, B, Looker, AC, Tosteson, AN, Johansson, H, Kanis, JA, Melton, LJ (2010) The potential impact of new National Osteoporosis Foundation guidance on treatment patterns. Osteoporos Int. 21: pp. 41-52 CrossRef
- Dawson-Hughes, B, Tosteson, ANA, Melton, LJ, Baim, S, Favus, ML, Khosla, S, Lindsay, RL (2008) Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 19: pp. 449-458 CrossRef
- Dell, R, Greene, D, Schelkun, SR, Williams, K (2008) Osteoporosis disease management: the role of the orthopaedic surgeon. J Bone Joint Surg Am 90: pp. 188-194 CrossRef
- Dumitrescu, B, Helden, S, ten Broeke, R, Nieuwenhuijzen-Kruseman, A, Wyers, C, Udrea, G, Linden, S, Geusens, P (2008) Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach. BMC Musculoskelet Disord 9: pp. 109 CrossRef
- Ebeling, PR (2008) Clinical practice. Osteoporosis in men. N Engl J Med. 358: pp. 1474-1482
- Edwards, BJ, Langman, CB, Bunta, AD, Vicuna, M, Favus, M (2008) Secondary contributors to bone loss in osteoporosis related hip fractures. Osteoporos Int. 19: pp. 991-999 CrossRef
- Elliot-Gibson, V, Bogoch, ER, Jamal, SA, Beaton, DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int. 15: pp. 767-778 CrossRef
- Ettinger, B (2008) A personal perspective on fracture risk assessment tools. Menopause. 15: pp. 1023-1026 CrossRef
- FORE Foundation for Osteoporosis Research and Education. 10-year Fracture Risk Calculator. Available at: http://riskcalculator.fore.org/. Accessed March 7, 2011.
- FRAX®. WHO Fracture Risk Assessment Tool. Available at: http://www.shef.ac.uk/FRAX/tool.jsp. Accessed March 8, 2011.
- Freedman, KB, Kaplan, FS, Bilker, WB, Strom, BL, Lowe, RA (2000) Treatment of osteoporosis: are physicians missing an opportunity?. J Bone Joint Surg Am. 82: pp. 1063-1070
- Gardner, MJ, Brophy, RH, Demetrakopoulos, D, Koob, J, Hong, R, Rana, A, Lin, JT, Lane, JM (2005) Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. J Bone Joint Surg Am. 87: pp. 3-7 CrossRef
- Gardner, MJ, Flik, KR, Mooar, P, Lane, JM (2002) Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am. 84: pp. 1342-1348 CrossRef
- Giangregorio, L, Papaioannou, A, Cranney, A, Zytaruk, N, Adachi, JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum. 35: pp. 293-305 CrossRef
- Glowacki, J, Harris, MB, Simon, J, Wright, J, Kolatkar, NS, Thornhill, TS, Leboff, MS (2010) Brigham fracture intervention team initiatives for hospital patients with hip fractures: a paradigm shift. Int J Endocrinol. 2010: pp. 590751
- Haaland, DA, Cohen, DR, Kennedy, CC, Khalidi, NA, Adachi, JD, Papaioannou, A (2009) Closing the osteoporosis care gap: increased osteoporosis awareness among geriatrics and rehabilitation teams. BMC Geriatr. 9: pp. 28 CrossRef
- Harrington, JT, Broy, SB, Derosa, AM, Licata, AA, Shewmon, DA (2002) Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum. 47: pp. 651-654 CrossRef
- Harrington, JT, Deal, CL (2006) Successes and failures in improving osteoporosis care after fragility fracture: results of a multiple-site clinical improvement project. Arthritis Rheum. 55: pp. 724-728 CrossRef
- Hawker, G, Ridout, R, Ricupero, M, Jaglal, S, Bogoch, E (2003) The impact of a simple fracture clinic intervention in improving the diagnosis and treatment of osteoporosis in fragility fracture patients. Osteoporos Int. 14: pp. 171-178 CrossRef
- Jaglal, SB, Hawker, G, Bansod, V, Salbach, NM, Zwarenstein, M, Carroll, J, Brooks, D, Cameron, C, Bogoch, E, Jaakkimainen, L, Kreder, H (2009) A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada. Osteoporos Int. 20: pp. 265-274 CrossRef
- Kanis, JA, Johansson, H, Oden, A, Dawson-Hughes, B, Melton, LJ, McCloskey, EV (2010) The effects of a FRAX revision for the USA. Osteoporos Int. 21: pp. 35-40 CrossRef
- Kanis, JA, Johnell, O, Oden, A, Johansson, H, McCloskey, E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 19: pp. 385-397 CrossRef
- Kuo, I, Ong, C, Simmons, L, Bliuc, D, Eisman, J, Center, J (2007) Successful direct intervention for osteoporosis in patients with minimal trauma fractures. Osteoporosis Int. 18: pp. 1633-1639 CrossRef
- LaBresh, KA, Ellrodt, AG, Gliklich, R, Liljestrand, J, Peto, R (2004) Get With the Guidelines for cardiovascular secondary prevention: pilot results. Arch Intern Med. 164: pp. 203-209 CrossRef
- LeBoff, MS, Kohlmeier, L, Hurwitz, S, Franklin, J, Wright, J, Glowacki, J (1999) Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA. 281: pp. 1505-1511 CrossRef
- Lee, TH (2007) Eulogy for a quality measure. N Engl J Med. 357: pp. 1175-1177 CrossRef
- Leslie, WD, O’Donnell, S, Jean, S, Lagacé, C, Walsh, P, Bancej, C, Morin, S, Hanley, DA, Papaioannou, A (2009) Trends in hip fracture rates in Canada. JAMA. 302: pp. 883-889 CrossRef
- Majumdar, SR, Johnson, JA, McAlister, FA, Bellerose, D, Russell, AS, Hanley, DA, Morrish, DW, Maksymowych, WP, Rowe, BH (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ. 178: pp. 569-575 CrossRef
- 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: pp. 1028-1034 CrossRef
- Mechanic, D (2010) Replicating high-quality medical care organizations. JAMA. 303: pp. 555-556 CrossRef
- National Committee for Quality Assurance. The state of health care quality: 2009. Available at: www.ncqa.org/tabid/836/Default.aspx. Accessed March 7, 2011.
- Nayak, S, Roberts, MS, Greenspan, SL (2009) Factors associated with diagnosis and treatment of osteoporosis in older adults. Osteoporos Int. 20: pp. 1963-1967 CrossRef
- Newman, ED, Ayoub, WT, Starkey, RH, Diehl, JM, Wood, GC (2003) Osteoporosis disease management in a rural health care population: hip fracture reduction and reduced costs in postmenopausal women after 5 years. Osteoporos Int. 14: pp. 146-151
- Nguyen, TV, Eisman, JA, Kelly, PJ, Sambrook, PN (1996) Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol. 144: pp. 255-263
- Peters, E, Hibbard, J, Slovic, P, Dieckmann, N (2007) Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Aff (Millwood) 26: pp. 741-748 CrossRef
- Siris, ES, Bilezikian, JP, Rubin, MR, Black, DM, Bockman, RS, Bone, HG, Hochberg, MC, McClung, MR, Schnitzer, TJ (2003) Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab. 88: pp. 3482-3486 CrossRef
- Skedros, JG, Holyoak, JD, Pitts, TC (2006) Knowledge and opinions of orthopaedic surgeons concerning medical evaluation and treatment of patients with osteoporotic fracture. J Bone Joint Surg Am. 88: pp. 18-24 CrossRef
- Solomon, DH, Finkelstein, JS, Polinski, JM, Arnold, M, Licari, A, Cabral, D, Canning, C, Avorn, J, Katz, JN (2006) A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporos Int. 17: pp. 760-767 CrossRef
- Streeten, EA, Mohamed, A, Gandhi, A, Orwig, D, Sack, P, Sterling, R, Pellegrini, VD (2006) The inpatient consultation approach to osteoporosis treatment in patients with a fracture. Is automatic consultation needed?. J Bone Joint Surg Am 88: pp. 1968-1974 CrossRef
- Switzer, JA, Jaglal, S, Bogoch, ER (2009) Overcoming barriers to osteoporosis care in vulnerable elderly patients with hip fractures. J Orthop Trauma. 23: pp. 454-459 CrossRef
- Tosi, LL, Gliklich, R, Kannan, K, Koval, KJ (2008) The American Orthopaedic Association’s ‘Own the Bone’ initiative to prevent secondary fractures. J Bone Joint Surg Am. 90: pp. 163-173 CrossRef
- Tosteson, ANA, Melton, LJ, Dawson-Hughes, B, Baim, S, Favus, MJ, Khosla, S, Lindsay, RL (2008) Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 19: pp. 437-447 CrossRef
- US Preventive Services Task Force, Agency for Healthcare Research and Quality. Screening for Osteoporosis in Postmenopausal Women. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsoste.htm. Accessed March 8, 2011.
- Warriner, AH, Curtis, JR (2009) Adherence to osteoporosis treatments: room for improvement. Curr Opin Rheumatol. 21: pp. 356-362 CrossRef
- Watts, BN (2002) Bone quality: getting closer to a definition. J Bone Miner Res. 17: pp. 1139-1147 CrossRef
- Weiss, TW, Siris, ES, Barrett-Connor, E, Miller, PD, McHorney, CA (2007) Osteoporosis practice patterns in 2006 among primary care physicians participating in the NORA study. Osteoporos Int. 18: pp. 1473-1480 CrossRef
- Yood, RA, Mazor, KM, Andrade, SE, Emani, S, Chan, W, Kahler, KH (2008) Patient decision to initiate therapy for osteoporosis: the influence of knowledge and beliefs. J Gen Intern Med. 23: pp. 1815-1821 CrossRef
- Bone Quality: Educational Tools for Patients, Physicians, and Educators
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- 1. George Washington University School of Medicine, Washington, DC, USA
- 2. Bone Health Program, Division of Orthopaedic Surgery and Sports Medicine, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA