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Original article

Vol. 144 No. 0910 (2014)

Gynaecologists’ awareness of bone healthcare in Switzerland

  • Petra Stute
  • Martin Birkhäuser
  • Michael von Wolff
  • Christian Meier
DOI
https://doi.org/10.4414/smw.2014.13931
Cite this as:
Swiss Med Wkly. 2014;144:w13931
Published
23.02.2014

Summary

PRINCIPLES: To assess gynaecologists’ awareness of bone healthcare in women and the prevalence of application of national recommendations on bone healthcare in Switzerland.

METHODS: During the annual meeting of the Swiss Society of Gynaecology and Obstetrics 2012, the Swiss Association against Osteoporosis (SVGO) performed standardised interviews with conference participants (n = 210). Questions addressed responsibility for bone healthcare, and whether diagnostic procedures, initiation of bone-specific treatment and follow-up were performed in accordance with SVGO recommendations.

RESULTS: The majority of respondents were aged 30–50 years (60%), female (70%) and working as board-certified gynaecologists (69%). Ninety-three percent of respondents considered care for bone health as part of the gynaecologist’s expertise. As diagnostic procedures, 44% recommended performing bone densitometry (DXA) only, 34% ordered additional laboratory testing. Seventy-two percent of respondents initiated a bone-specific treatment. Predictors for not performing diagnostic procedures and not initiating a bone-specific treatment were physician’s age below 30, being a trainee gynaecologist, and working at a university clinic. Particularly, young trainee gynaecologists working at a university clinic were especially unlikely to initiate a bone-specific treatment (regression coefficient = –2.68; odds ratio [OR] 0.069, 95% confidence interval [CI] 0.01–0.61; p = 0.16). Follow-ups were performed by 77% of respondents, but were less likely to be by female physicians (OR 0.27, 95% CI 0.09–0.84; p = 0.024).

CONCLUSIONS: Although the majority of board-certified gynaecologists follow national recommendations on bone healthcare, current medical training in obstetrics and gynaecology does not sufficiently cover the subject of women’s health. However, since this is a small study our findings may not reflect the findings in the total population.

References

  1. Lippuner K. [Epidemiology and burden of osteoporosis in Switzerland]. Ther Umsch. 2012;69(3):137–44.
  2. Ceausu I. Education and information: important tools in assessing the risks and prevention of osteoporosis fractures. Climacteric. 2010;13(6):530–3.
  3. Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD, et al. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2010;95(7 Suppl 1):s1–s66.
  4. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–33.
  5. Lippuner K. The future of osteoporosis treatment – a research update. Swiss Med Wkly. 2012;142:w13624.
  6. Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E. FRAX and its applications to clinical practice. Bone. 2009;44(5):734–43.
  7. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19(4):385–97.
  8. Laliberte MC, Perreault S, Jouini G, Shea BJ, Lalonde L. Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis. Osteoporos Int. 2011;22(11):2743–68.
  9. Teng GG, Warriner A, Curtis JR, Saag KG. Improving quality of care in osteoporosis: opportunities and challenges. Curr Rheumatol Rep. 2008;10(2):123–30.
  10. Meadows ES, Mitchell BD, Bolge SC, Johnston JA, Col NF. Factors associated with treatment of women with osteoporosis or osteopenia from a national survey. BMC Womens Health. 2012;12:1.
  11. Brennan RM, Wactawski-Wende J, Crespo CJ, Dmochowski J. Factors associated with treatment initiation after osteoporosis screening. Am J Epidemiol. 2004;160(5):475–83.
  12. Mudano AS, Casebeer L, Patino F, Allison JJ, Weissman NW, Kiefe CI, et al. Racial disparities in osteoporosis prevention in a managed care population. South Med J. 2003;96(5):445–51.
  13. Neuner JM, Zhang X, Sparapani R, Laud PW, Nattinger AB. Racial and socioeconomic disparities in bone density testing before and after hip fracture. J Gen Intern Med. 2007;22(9):1239–45.
  14. Demeter S, Leslie WD, Lix L, MacWilliam L, Finlayson GS, Reed M. The effect of socioeconomic status on bone density testing in a public health-care system. Osteoporos Int. 2007;18(2):153–8.
  15. Solomon DH, Katz JN, Jacobs JP, La Tourette AM, Coblyn J. Management of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis: rates and predictors of care in an academic rheumatology practice. Arthritis Rheum. 2002;46(12):3136–42.
  16. Grover M, Anderson M, Gupta R, Haden M, Hartmark-Hill J, Morski LM, et al. Increased osteoporosis screening rates associated with the provision of a preventive health examination. J Am Board Fam Med. 2009;22(6):655–62.
  17. Wall E, Walker-Bone K. Use of bisphosphonates and dual-energy X-ray absorptiometry scans in the prevention and treatment of glucocorticoid-induced osteoporosis in rheumatology. QJM. 2008;101(4):317–23.
  18. Gera C, Vij AS. Glucocorticoid-induced osteoporosis: unawareness or negligence in India? Int J Rheum Dis. 2009;12(3):230–3.
  19. Ledwich LJ, Clarke K. Screening and treatment of glucocorticoid-induced osteoporosis in rheumatoid arthritis patients in an urban multispecialty practice. J Clin Rheumatol. 2009;15(2):61–4.
  20. Heberlein I, Demary W, Bloching H, Braun J, Buttgereit F, Dreher R, et al. [Diagnosis and treatment of osteoporosis and rheumatoid arthritis in accordance with German guidelines. Results of a survey of patients, primary care physicians and rheumatologists]. Z Rheumatol. 2011;70(7):592–601.
  21. Kirigaya D, Nakayama T, Ishizaki T, Ikeda S, Satoh T. Management and treatment of osteoporosis in patients receiving long-term glucocorticoid treatment: current status of adherence to clinical guidelines and related factors. Intern Med. 2011;50(22):2793–800.
  22. Majumdar SR, Lix LM, Yogendran M, Morin SN, Metge CJ, Leslie WD. Population-based trends in osteoporosis management after new initiations of long-term systemic glucocorticoids (1998–2008). J Clin Endocrinol Metab. 2012;97(4):1236–42.
  23. Wagnon JH, Leiman DA, Ayers GD, Schwartz DA. Survey of gastroenterologists' awareness and implementation of AGA guidelines on osteoporosis in inflammatory bowel disease patients: are the guidelines being used and what are the barriers to their use? Inflamm Bowel Dis. 2009;15(7):1082–9.
  24. Suhm N, Lamy O, Lippuner K, OsteoCare study g. Management of fragility fractures in Switzerland: results of a nationwide survey. Swiss Med Wkly. 2008;138(45–46):674–83.
  25. Solomon DH, Brookhart MA, Gandhi TK, Karson A, Gharib S, Orav EJ, et al. Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics. Am J Med. 2004;117(12):919–24.
  26. Cohen K, Maier D. Osteoporosis: evaluation of screening patterns in a primary-care group practice. J Clin Densitom. 2008;11(4):498–502.
  27. Cranney A, Tsang JF, Leslie WD. Factors predicting osteoporosis treatment initiation in a regionally based cohort. Osteoporos Int. 2009;20(9):1621–5.
  28. Fraser LA, Ioannidis G, Adachi JD, Pickard L, Kaiser SM, Prior J, et al. Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study. Osteoporos Int. 2011;22(3):789–96.
  29. Guggenbuhl P, Dufour R, Liu-Leage S, Sapin H, Cortet B. Efficiency of bone density testing by dual-biphotonic X-rays absorptiometry for diagnosis of osteoporosis according to French guideline recommendations: the PRESAGE study. Joint Bone Spine. 2011;78(5):493–8.
  30. Powell H, O'Connor K, Greenberg D. Adherence to the U.S. Preventive Services Task Force 2002 osteoporosis screening guidelines in academic primary care settings. J Womens Health (Larchmt). 2012;21(1):50–3.
  31. Buencamino MC, Sikon AL, Jain A, Thacker HL. An observational study on the adherence to treatment guidelines of osteopenia. J Womens Health (Larchmt). 2009;18(6):873–81.
  32. Mountjoy CR, Shrader SP, Ragucci KR. Compliance with osteoporosis treatment guidelines in postmenopausal women. Ann Pharmacother. 2009;43(2):242–50.
  33. Castel H, Bonneh DY, Sherf M, Liel Y. Awareness of osteoporosis and compliance with management guidelines in patients with newly diagnosed low-impact fractures. Osteoporos Int. 2001;12(7):559–64.
  34. Cortet B. [Postmenopausal osteoporosis: general practitioners' application of the risk factors in the AFSSAPS guidelines. Survey of 2658 general practitioners ]. Presse Med. 2009;38(9):1213–9.
  35. Chenot R, Scheidt-Nave C, Gabler S, Kochen MM, Himmel W. German primary care doctors' awareness of osteoporosis and knowledge of national guidelines. Exp Clin Endocrinol Diabetes. 2007;115(9):584–9.
  36. Butzlaff M, Kempkens D, Schnee M, Dieterle WE, Bocken J, Rieger MA. German ambulatory care physicians' perspectives on clinical guidelines – a national survey. BMC Fam Pract. 2006;7:47.
  37. Jaglal SB, McIsaac WJ, Hawker G, Carroll J, Jaakkimainen L, Cadarette SM, et al. Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporos Int. 2003;14(8):672–6.
  38. Ouimet M, Landry R, Amara N, Belkhodja O. What factors induce health care decision-makers to use clinical guidelines? Evidence from provincial health ministries, regional health authorities and hospitals in Canada. Soc Sci Med. 2006;62(4):964–76.
  39. Taylor JC, Sterkel B, Utley M, Shipley M, Newman S, Horton M, et al. Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management. Osteoporos Int. 2001;12(10):844–8.

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