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

  • Author / Creator
    Knopp-Sihota, Jennifer A
  • 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.

  • Subjects / Keywords
  • Graduation date
    2012-11
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/R3BS8X
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Doctoral
  • Department
    • Faculty of Nursing
  • Supervisor / co-supervisor and their department(s)
    • Cummings, Greta (Faculty of Nursing)
  • Examining committee members and their departments
    • Homik, Joanne (Department of Medicine)
    • Voaklander, Don (School of Public Health)
    • Estabrooks, Carol (Faculty of Nursing)
    • Milisen, Koen (Center for Health Services and Nursing Research, Catholic University Leuven, Leuven [Belgium])