Awareness of osteoporosis risk assessment tools and screening recommendations among community pharmacists in Malaysia


Background The incidence of osteoporosis in Malaysia is increasing due to a fast-ageing population. Because of its silent nature, various osteoporosis risk assessment tools exist to detect high-risk patients and facilitate referrals for bone mineral density measurements. As an accessible point of contact, community pharmacists would benefit from the utilization of these tools and familiarity with guideline recommendations for osteoporosis screening. Aim This study aimed to investigate the awareness of osteoporosis risk assessment tools, practice behaviour towards osteoporosis, and knowledge of guideline recommendations among community pharmacists in the Klang Valley, Malaysia. Setting Community pharmacies. Methods This study was a cross-sectional study which sampled 284 community pharmacists practicing in the Klang Valley, using a stratified sampling approach. The study was conducted using a self-administered questionnaire which was divided into three sections: demographic data, knowledge of osteoporosis risk assessment tools and guideline recommendations, and practice behaviour towards osteoporosis. Practice behaviour was assessed with 15 items using a 5-point Likert scale. Main outcome measure. Proportion of respondents aware of osteoporosis risk assessment tools and respondent knowledge on guideline recommendations for osteoporosis screening. Results A total of 284 community pharmacists participated in the study. 84.1% of the respondents were aware of at least one risk assessment tool. However, only a small proportion of pharmacists (14.9%) regularly used these tools in their practice. Respondents perceived these tools to be relevant and beneficial, but perception towards their accessibility, ease-of-use, and administration time was mixed, suggesting unfamiliarity. Respondents preferred to conduct clinical assessments based on risk factors, with respondents identifying a mean of 10.1 ± 3.4 out of 15 risk factors. However, several clinically relevant risk factors were frequently unidentified. Knowledge of guideline recommendations among respondents was low. Conclusion There is some awareness of osteoporosis risk assessment tools but use in practice remains low among community pharmacists in Malaysia. There is potential to increase the use of these tools and knowledge of recommendations for osteoporosis screening and referral among community pharmacists.

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  1. 1.

    Department of Economic and Social Affairs, United Nations Population Division. World Population Prospects: The 2017 Revision. 2017. Accessed 18 Aug 2020.

  2. 2.

    Department of Statistics Malaysia. Population Projection. 2016. Accessed 18 Aug 2020.

  3. 3.

    International Osteoporosis Foundation. The Asia-Pacific Regional Audit: Epidemiology, costs & burden of osteoporosis in 2013. 2013. Accessed 18 Augt 2020.

  4. 4.

    Schousboe JT, Ensrud KE, Nyman JA, Melton LJ, Kane RL. Universal bone densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is highly cost-effective for elderly women. J Am Geriatr Soc. 2005;53:1697–704.

    Article  Google Scholar 

  5. 5.

    Dawson-Hughes B, Tosteson ANA, Melton LJ, Baim S, Favus MJ, Khosla S, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19:449–58.

    CAS  Article  Google Scholar 

  6. 6.

    Häussler B, Gothe H, Göl D, Glaeske G, Pientka L, Felsenberg D. Epidemiology, treatment and costs of osteoporosis in Germany—the BoneEVA study. Osteoporos Int. 2007;18:77–84.

    Article  Google Scholar 

  7. 7.

    Varacallo MA, Fox EJ. Osteoporosis and its complications. Med Clin North Am. 2014;98:817–31.

    Article  Google Scholar 

  8. 8.

    Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990;45:M101-7.

    Article  Google Scholar 

  9. 9.

    Cooper C, Atkinson EJ, Jacobsen SJ, O’fallon WM, Melton LJ. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137:1001–5.

    CAS  Article  Google Scholar 

  10. 10.

    Leibson CL, Tosteson ANA, Gabriel SE, Ransom JE, Melton LJ. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc. 2002;50:1644–50.

    Article  Google Scholar 

  11. 11.

    Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726–33.

    CAS  Article  Google Scholar 

  12. 12.

    Lau EMC, Lee JK, Suriwongpaisal P, Saw SM, Das De S, Khir A, et al. The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int. 2001;12:239–43.

    CAS  Article  Google Scholar 

  13. 13.

    Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for osteoporosis to prevent fractures us preventive services task force recommendation statement. JAMA. 2018;319:2521–31.

    Article  Google Scholar 

  14. 14.

    Pouilles JM, Tremollieres F, Todorovsky N, Ribot C. Precision and sensitivity of dual-energy X‐ray absorptiometry in spinal osteoporosis. J Bone Miner Res. 1991;6:997–1002.

    CAS  Article  Google Scholar 

  15. 15.

    Humadi A, Alhadithi R, Alkudiari S. Validity of the DEXA diagnosis of involutional osteoporosis in patients with femoral neck fractures. Indian J Orthop. 2010;44:73–8.

    Article  Google Scholar 

  16. 16.

    Malaysian Osteoporosis Society. Clinical Guidance on Management of Osteoporosis 2012. 2012. Accessed 18 Aug 2020.

  17. 17.

    Koh LKH, Ben Sedrine W, Torralba TP, Kung A, Fujiwara S, Chan SP, et al. A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int. 2001;12:699–705.

    CAS  Article  Google Scholar 

  18. 18.

    Kanis JA, Oden A, Johansson H, Borgström F, Ström O, McCloskey E. FRAX® and its applications to clinical practice. Bone. 2009;44:734–43.

    Article  Google Scholar 

  19. 19.

    Hajcsar EE, Hawker G, Bogoch ER. Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ. 2000;163:819–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Toh LS, Lai PSM, Othman S, Shah A, Dang CPL, Low BY, et al. Exploring the current and future role of the pharmacists in osteoporosis screening and management in Malaysia. Int J Clin Pharm. 2018;40:450–7.

    CAS  Article  Google Scholar 

  21. 21.

    Goode JV, Swiger K, Bluml BM. Regional osteoporosis screening, referral, and monitoring program in community pharmacies: findings from project ImPACT: osteoporosis. J Am Pharm Assoc. 2004;44:152–60.

    Article  Google Scholar 

  22. 22.

    Toh LS, Lai PSM, Low BY, Wong KT, Anderson C. Feasibility of an interprofessional collaborative osteoporosis screening programme in Malaysia. Int J Clin Pharm. 2020;42:11–7.

    Article  Google Scholar 

  23. 23.

    Yuksel N, Majumdar SR, Biggs C, Tsuyuki RT. Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial. Osteoporos Int. 2010;21:391–8.

    CAS  Article  Google Scholar 

  24. 24.

    Summers KM, Brock TP. Impact of pharmacist-led community bone mineral density screenings. Ann Pharmacother. 2005;39:243–8.

    Article  Google Scholar 

  25. 25.

    Khan YH, Mallhi TH, Sarriff A, Khan AH. Osteoporosis: are healthcare professionals missing an opportunity. Springerplus. 2013;2:1–5.

    CAS  Article  Google Scholar 

  26. 26.

    Nik J, Lai PSM, Ng CJ, Emmerton L. A qualitative study of community pharmacists’ opinions on the provision of osteoporosis disease state management services in Malaysia. BMC Health Serv Res. 2016;16:448.

    Article  Google Scholar 

  27. 27.

    Toh LS, Lai PSM, Wu DB-C, Bell BG, Dang CPL, Low BY, et al. A comparison of 6 osteoporosis risk assessment tools among postmenopausal women in Kuala Lumpur, Malaysia. Osteoporos Sarcopenia. 2019;5:87–93.

    Article  Google Scholar 

  28. 28.

    Brookhart AL, Brown Fountain KM, Moczygemba LR, Goode JVR. Community pharmacist-provided osteoporosis screening and education: impact on patient knowledge. Innov Pharm. 2015;6:213.

    Article  Google Scholar 

  29. 29.

    Tosteson ANA, Melton LJ, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19:437–47.

    CAS  Article  Google Scholar 

  30. 30.

    Coyle D. Cost-effectiveness of pharmacological treatments for osteoporosis consistent with the revised economic evaluation guidelines for Canada. MDM Policy Pract. 2019;4:2381468318818843.

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Wasserfallen JB, Krieg MA, Greiner RA, Lamy O. Cost effectiveness and cost utility of risedronate for osteoporosis treatment and fracture prevention in women: a Swiss perspective. J Med Econ. 2008;11:499–523.

    Article  Google Scholar 

  32. 32.

    Chaiyakunapruk N, Laowakul A, Karnchanarat S, Pikulthong N, Ongphiphadhanakul B. Community pharmacy-based implementation and evaluation of an Osteoporosis Self-Assessment Tool for Asians. J Am Pharm Assoc. 2006;46:391–6.

    Article  Google Scholar 

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Correspondence to Jason S. E. Loo.

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Francis, J., Toh, L.S., Sellappans, R. et al. Awareness of osteoporosis risk assessment tools and screening recommendations among community pharmacists in Malaysia. Int J Clin Pharm (2021).

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  • Community pharmacy
  • Osteoporosis
  • Screening