CALCIUM SUPPLEMENT AND OSTEOPOROSIS MEDICATION USE IN WOMEN AND MEN WITH RECENT FRACTURES

Authors: PRO-RISQUEZ, ALEJANDRA - BROOKLINE ASSC INTERN MED; HARRIS, SUSAN - NE RESEARCH INSTITUTE; SONG, LINGYI - TUFTS-HNRCA; RUDICEL, SALLY - TUFTS-NEMC; BARNEWOLT, BRIEN - TUFTS-NEMC; DAWSON-HUGHES, BESS - TUFTS-HNRCA

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/25/2003
Publication Date: 6/7/2004
Citation: Pro-Risquez, A., Harris, S.S., Song, L., Rudicel, S., Barnewolt, B., Dawson-Hughes, B. 2004. Calcium supplement and osteoporosis medication use in women and men with recent fractures. Osteoporosis International. 15:689-694.

Interpretive Summary: Osteoporosis is the most common bone disease in the United States reaching epidemic proportions in the elderly population. In adults, an osteoporotic fracture can be an indicator for risk of future fractures. When an acute fracture occurs, the experts recommend optimal calcium and vitamin D intakes as well as an osteoporosis evaluation and the use of prescription bone medication as well as assessing calcium intake and vitamin D, which has been shown to reduce fracture risk. Several studies show that patients with recent fractures are not adequately treated to prevent subsequent fractures. This study looks at 106 acute fracture patients, men and women approximately 67 years of age, who were given medical history and diet questionnaires at the time of the fracture. These questionnaires were repeated again 6 and 12 months later to see who among them had been treated. Of 86 patients contacted 6 months after their fracture, 36.2% of the women and 7.4% of the men had recently discussed osteoporosis with their primary care doctor. At 6 months, 52.6% of the women and 10% of the men indicated that their doctor had recently recommended calcium or vitamin D, and 24.2% of the women and 3.6% of the men were taking bone medications. Among the women who were advised to use calcium or vitamin D, supplement use increased from 63.3% to 90.0% and dairy food intake almost doubled. At 12 months, the treatment profiles were unchanged and 9.6% of the women and 4.3% of the men had another fracture. In conclusion, the occurrence of a fracture did not increase the likelihood of treatment for osteoporosis, either with calcium and vitamin D supplements or medication. Those patients who did use supplements and increased their dietary intake of calcium did so as a direct result of recommendations from their primary care physician. This suggests that the primary care physician is the key to improving nutrition and other care of fracture patients.

Technical Abstract: It is well known that patients with low-trauma fractures are at greater risk for future fractures and that they stand to benefit from evaluation and treatment for osteoporosis. Treatment consists of supplementation with calcium and vitamin D and/or the use of a bone medication. This study assesses the prevalence of these recommendations by primary care physicians at the time of and after an acute fracture. At enrollment, 106 subjects, mean age 66.7+/-10.3 yrs, were given medical history and diet questionnaires and again 6 and 12 months later (by telephone). Of 86 subjects who could be contacted 6 months after their fracture, 36.2% of the women and 7.4% of the men had recently discussed osteoporosis with their physician. At 6 months, 24.2% of the women and 3.6% of the men were taking bone medications (compared with 27.8% and 3.6% before the fracture, ns). At 6 months, 52.6% of the women and 10.7% of the men indicated that their doctor had recently recommended calcium or vitamin D. Among the women who had recently been advised by their primary care doctor to use calcium or vitamin D, supplement use increased from 63.3% to 90.0% (P= 0.021) and dairy food intake increased from 1.5 +/- 1.1 to 2.4 +/- 1.9 servings/d (P= 0.016). Only 3 men received this advice and 2 of them heeded it. Among women and men not receiving this advice, there was no significant increase in calcium supplement use or dairy food intake. At 12 months, the treatment profiles were unchanged from 6 months and 9.6% of the women and 4.3% of the men had had another fracture. This suggests that the occurrence of a fracture did not increase the likelihood of treatment for osteoporosis. After their fractures, the women did increase their intake of calcium supplements and dairy foods when it was recommended by their doctor. This suggests that the primary care physician is well positioned to bring about much needed change in the quality of care of fracture patients.