Among individuals presenting to an Ontario FLS, we compared bone active medication initiation rates of patients 80 years and older with those 50–79 years old. After accounting for fracture risk status, there was no statistically significant difference in medication initiation rates between the two age groups
A Fracture Liaison Service (FLS) offers post-fracture services to individuals over the age of 50 years and could potentially address age inequities in pharmacotherapy often observed for older adults. Among individuals presenting to an Ontario FLS and classified as being at high risk for future fracture, our objective was to compare bone active medication initiation rates of patients 80 years and older with those 50–79 years old.
In 39 FLS fracture clinics across Ontario, Canada, fracture prevention coordinators identified, assessed, and facilitated the referral of eligible patients for bone densitometry, fracture risk assessment, and implementation of pharmacotherapy in patients classified as high risk for future fracture. Variables assessed at baseline included age, sex, marital status, living location, fracture location, history of previous fracture, parent’s history of hip fracture, history of falls, and fracture risk status. At 6 months, bone active medication initiation was assessed in patients classified as high risk for future fracture. The Chi-square test of independence was used to compare medication initiation rates between patients 80 + and those 50–79 years old.
Our sample size consisted of 808 patients aged 50–79 years and 346 aged 80 + years. After accounting for fracture risk status, there was no statistically significant difference in medication initiation rates of patients 50–79 and 80 + years old (76.9% versus 73.7%, p = 0.251).
A systematic approach to identifying patients at high risk for future fracture and tailoring treatment recommendations to these patients appeared to eliminate differences in treatment initiation rates based on older age.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Andersen S, Laurberg P (2014) Age discrimination in osteoporosis screening - data from the Aalborg University Hospital record for osteoporosis risk assessment. Maturitas 77:330–335
Balasubramanian A, Tosi LL, Lane JM, Dirschl DR, Ho P-R, O'Malley CD (2014) Declining rates of osteoporosis management following fragility fractures in the U.S., 2000 through 2009. Journal of Bone & Joint Surgery 96:e52 (1–8)
Bawa HS, Weick J, Dirschl DR (2015) Anti-osteoporotic therapy after fragility fracture lowers rate of subsequent fracture. Journal of Bone & Joint Surgery 97:1555–1562
Axelsson KF, Jacobsson R, Lund D, Lorentzon M (2016) Effectiveness of a minimal resource fracture liaison service. Osteoporos Int 27:3165–3175
Hiligsmann M, Bruyere O, Reginster J-Y (2010) Cost-utility of long-term strontium ranelate treatment for postmenopausal osteoporotic women. Osteoporos Int 21:157–165
Hiligsmann M, Reginster J-Y (2010) Potential cost-effectiveness of denosumab for the treatment of postmenopausal osteoporotic women. Bone 47:34–40
Klop C, Welsing PMJ, Elders PJM, Overbeek JA, Souverein PC, Burden AM, van Onzenoort HAW, Leufkens HGM, Bijlsma JWJ, de Vries F (2015) Long-term persistence with anti-osteoporosis drugs after fracture. Osteoporos Int 26:1831–1840
Mitchell PJ, Cooper C, Fujita M, Halbout P, Åkesson K, Costa M, Dreinhöfer KE, Marsh DR, Lee JK, Chan DC, Javaid MK (2019) Quality improvement initiatives in fragility fracture care and prevention. Current Osteoporosis Reports 17:510–520
Papaioannou A, Leslie WD, Morin S et al (2010) 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J 182(17):1864–1873
Sale JEM, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2011) Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporososis International 22(7):2067–2082
Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24:393–406
Blonk MC, Erdtsieck RJ, Wernekinck MG, Schoon EJ (2007) The fracture and osteoporosis clinic: 1-year results and 3-month compliance. Bone. 40(6):1643–1649
Banefelt J, Akesson KE, Spangeus A et al (2019) Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int 30:601–609
Yusuf AA, Hu Y, Chandler D, Crittenden DB, Barron RL (2020) Predictors of imminent risk of fracture in Medicare-enrolled men and women. Arch Osteoporos 15:120
Dirschl DR, Rustom BS (2018) Practice patterns and performance in U.S. Fracture Liaison Programs. Journal of Bone & Joint Surgery 100:680–685
Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15,000 adults. Journal of Bone & Joint Surgery (Br) 80B(2):243–248
Metge CJ, Leslie WD, Manness L-J, Yogendran M, Yuen CK, Kvern B, Maximizing Osteoporosis Management in Manitoba Steering Committee (2008) Postfracture care for older women: gaps between optimal care and actual care. Can Fam Physician 54:1270–1276
Siminoski K, Leslie WD, Frame H et al (2005) Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 56(3):178–188
Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2010) Independent clinical validation of a Canadian FRAX tool: fracture prediction and model calibration. J Bone Miner Res 25(11):2350–2358. https://doi.org/10.1002/jbmr.123 [published Online First: Epub Date]
Agresti A (2003) Categorical data analysis. John Wiley & Sons, Hoboken
Rice JA (2006) Mathematical statistics and data analysis. Belmont, Thompson Higher Education
Rana R, Singhal R (2015) Chi-square test and its application in hypothesis testing. Journal of the Practice of Cardiovascular Sciences 1(1):69
Tripepi G, Jager KJ, Dekker FW, Wanner C, Zoccali C (2007) Measures of effect: relative risks, odds ratios, risk difference, and 'number needed to treat'. Kidney Int 72(7):789–791
Bland JM, Altman DG (1995) Multiple significance tests: the Bonferroni method. BMJ 310(6973):170
Kim HY (2017) Statistical notes for clinical researchers: chi-squared test and Fisher's exact test. Restorative Dentistry & Endodontics 42(2):152–155
Pickering RM (2017) Describing the participants in a study. Age Ageing 46:576–581
Tang J, Galbraith N (2016) Truong J. Living alone in Canada:1–21
Chang VC, Minh TD (2015) Risk factors for falls among seniors: implications of gender. Am J Epidemiol 181(7):521–531
Brandberg C, Blomqvist H, Jirwe M (2013) What is the importance of age on treatment of the elderly in the intensive care unit? Acta Anaesthesiol Scand 57:698–703
Bond M, Bowling A, McKee D, Kennelly M, Banning AP, Dudley N, Elder A, Martin A (2003) Does ageism affect the management of ischaemic heart disease? J Health Serv Res Policy 8(1):40–47
Giugliano RP, Camargo CA, Lloyd-Jones DM, Zagrodsky JD, Alexis JD, Eagle KA, Fuster V, O'Donnell CJ (1998) Elderly patients receive less aggressive medical and invasive management of unstable angina. Arch Intern Med 158:1113–1120
Held C, Johanson P, Edberg A et al (2013) Undertreatment of elderly patients >80-years with acute coronary syndrome despite high risk and similar benefits from evidence-based treatment as at younger age: Results from SWEDEHEART. J Am Coll Cardiol 61(10)
Avezum A, Makdisse M, Spencer F (2005) Impact of age on management and outcome of acute coronary syndrome: observations from the global registry of acute coronary events (GRACE). Am Heart J 149:67–73
Peake MD (2003) Ageism in the management of lung cancer. Age Ageing 32(2):171–177
Fourcadier E, Tretarre B, Gras-Aygon C, Ecarnot F, Daures J-P, Bessaoud R (2015) Under-treatment of elderly patients with ovarian cancer: a population based study. BMC Cancer 15:937
Audisio RA, Balch CM (2016) Why can't surgeons treat older patients the same as younger patients? Ann Surg Oncol 23(13):4123–4125
Parameswaran K, Hildreth A, Chadha D, Keaney N, Taylor I, Bansal S (1998) Asthma in the elderly: Underperceived, underdiagnosed and undertreated; a community survey. Respir Med 92(3):573–577
Swaminathan D, Swaminathan V (2015) Geriatric oncology: problems with undertreatment within this population. Cancer Biology & Medicine 12(4):275–283
Wyman MF, Shiovitz-Ezra S, Bengel J (2018) Ageism in the health care system: providers, patients, and systems. International Perspectives on Aging Contemporary Perspectives on Ageism:193–212
Higashi RT, Tillack AA, Steinman M, Harper M, Johnston CB (2012) Elder care as "frustrating" and "boring": understanding the persistence of negative attitudes toward older patients among physicians-in-training. J Aging Stud 26(4):476–483
Cherubini A, Oristrell J, Pla X, Ruggiero C, Ferretti R, Diestre G, Clarfield AM, Crome P, Hertogh C, Lesauskaite V, Prada GI, Szczerbinska K, Topinkova E, Sinclair-Cohen J, Edbrooke D, Mills GH (2011) The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med 171(6):550–556
Van Spall HGC, Toren A, Kiss A, Fowler RA (2007) Eligibility criteria of randomized controlled trials published in high-impact general medical journals: a systematic sampling review. JAMA 297(11):1233–1240
Bartlett C, Doyal L, Ebrahim S et al (2005) The causes and effects of socio-demographic exclusions from clinical trials. Health Technol Assess 9(38):1–171
Bohnert N, Chagnon J, Dion P (2015) Population projections for Canada (2013 to 2063), provinces and territories (2013 to 2038). Statistics Canada, Canada
Sale JE, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2014) Key outcomes are usually not reported in published fracture secondary prevention programs: results of a systematic review. Arch Orthop Trauma Surg 134(2):283–289. https://doi.org/10.1007/s00402-011-1442-y [published Online First: Epub Date]|
Axelsson KF, Johansson H, Lundh D, Moller M, Lorentzon M (2020) Association between recurrent fracture risk and implementation of fracture liaison services in four Swedish hospitals: a cohort study. J Bone Miner Res 35(7):1216–1223
Ansari H, Beaton D, Sujic R et al (2017) Equal treatment: no evidence of gender inequity in osteoporosis management in a coordinator-based fragility fracture screening program after fracture risk adjustment. Osteoporos Int 28(12):3401–3406
This study was supported by funding from the Ontario Ministry of Health and Long-Term Care (MOHLTC) through the Ontario Osteoporosis Strategy. The views expressed are those of the researchers and do not necessarily reflect those of the MOHLTC.
Conflict of interest
The authors JEMS, AY, VE-G, RJ, RS, DL, JW, LF, and EB declare that they have no conflict of interest. EB has an unrestricted research grant from Amgen Canada and serves on an advisory board for Amgen Canada.
The use of de-identified data for research purposes was approved by the research ethics board (REB#08-304) at St. Michael’s Hospital, Unity Health Toronto.
Consent to participate
Consent for publication
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Sale, J.E.M., Yang, A., Elliot-Gibson, V. et al. Patients 80 + have similar medication initiation rates to those aged 50–79 in Ontario FLS. Osteoporos Int (2021). https://doi.org/10.1007/s00198-020-05796-0
- Fracture liaison service
- Fracture risk
- Fragility fracture
- Medication initiation