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Management and Health Care Utilization for Osteoporosis and Osteoporosis-Related Fractures Open Access


Other title
older adults
health care utilization
Type of item
Degree grantor
University of Alberta
Author or creator
Knopp-Sihota, Jennifer A
Supervisor and department
Cummings, Greta (Faculty of Nursing)
Examining committee member and department
Estabrooks, Carol (Faculty of Nursing)
Voaklander, Don (School of Public Health)
Milisen, Koen (Center for Health Services and Nursing Research, Catholic University Leuven, Leuven [Belgium])
Homik, Joanne (Department of Medicine)
Faculty of Nursing

Date accepted
Graduation date
Doctor of Philosophy
Degree level
BACKGROUND: Osteoporosis is a skeletal disease characterized by low bone mass and deterioration of bone, leading to increased bone fragility and risk of fracture. PURPOSE: The purpose of this research was to examine clinical utilization patterns and use of osteoporosis medications, and their possible side effects, in relation to patient age and co-morbidity. METHODS / RESULTS: This dissertation included four interrelated studies; a systematic review and three population-based retrospective cohort studies utilizing administrative healthcare data, leading to four manuscripts for publication. The first paper was a systematic review of the use of salmon calcitonin for treating acute and chronic back pain of vertebral compression fractures. The findings suggested that calcitonin was effective for managing acute pain of recent fractures, but not for chronic back pain associated with more remote fractures. In the second paper, I examined the association between older age, co-morbidity, and treatment status of incident osteoporosis-related fractures. I found that the majority of patients, particularly those who were older, male, and lived in a remote location had not received osteoporosis treatment. In the third paper, I studied a cohort of patients with a diagnosis of osteoporosis and compared treatment rates based on dementia status. The findings of this paper suggested that the majority of older adults with a diagnosis of dementia, and fewer co-morbid conditions, had not received osteoporosis treatment. In the fourth and final paper, I examined a cohort of new users of bisphosphonate drugs (a common osteoporosis treatment) to determine if older patients were more likely to suffer serious upper gastrointestinal bleeding (UGIB) within 120 days of drug initiation. I found an overall low rate of UGIB, but confirmed that older patients (those > 80 years) were significantly more likely to develop an UGIB when compared to younger patients. CONCLUSIONS: The combined findings of these papers confirmed that despite the wide availability of osteoporosis medications, the majority of high risk patients (especially those who were older) were not receiving guideline recommended treatment. This information will be useful for clinicians and for policy makers to focus efforts on those most at risk for osteoporosis and related fractures.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Knopp-Sihota, J.A., Newburn-Cook, C.V., Homik, J., Cummings, G.G., & Voaklander, D., Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Osteoporos Int. 2012; 23(1): 17-38.Knopp-Sihota, J.A., Newburn-Cook, C.V., Cummings, G.G., Homik, J., & Voaklander, D., The association between older age, co-morbidity, and treatment status of incident osteoporotic fractures: A population-based nested cohort study. Osteoporos Int. 2011; 22(Suppl 2): S424.

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