Using a sequential explanatory mixed method to evaluate the therapeutic window of opportunity for initiating osteoporosis treatment following fragility fractures.

Interventions targeting patients with recent fragility fracture and their physician were most successful at initiating osteoporosis treatment during the first 12 months. This window of opportunity had already closed after 1 year. The reasons for declining or accepting the intensive intervention were explored in patients still untreated at 12 months. INTRODUCTION: A fragility fracture (FF) event identifies patients most likely to benefit from osteoporosis treatment. Nonetheless, most FF patients go untreated. Our objective was to determine how long an incident FF remains a strong incentive to initiate osteoporosis treatment. METHODS: A total of 1086 men and women over age 50 with a recent FF event were assigned to either standard care (SC), to minimal (MIN), or intensive (INT) interventions targeting patients and their family physician to initiate osteoporosis treatment. Inpatients with FF (mainly hip) evaluated by rheumatologists were also included in a specialized group (SPE; n = 324). At 1 year, untreated patients in both the SC and the MIN groups were offered an INT intervention. The cohort was followed through 48 months. A qualitative analysis of patient-centered decision-making associated with initiation of treatment was conducted. RESULTS: In MIN and INT groups, osteoporosis treatment was initiated in 41.0 and 54.3% of untreated patients by 12 months, respectively, compared to 68.4% in SPE and 18.9% in SC groups; initiation rates drastically dropped thereafter. Over 4863 patient-years of follow-up, the rates of new FF were 3.4 per 100 patient-years, without significant differences between patients with initial major or minor FF, nor between control or intervention groups. Failure by patients and physicians to recognize FF as a sign of underlying bone disease contributed the most to lack of treatment. CONCLUSION: While incident FFs are an ideal opportunity for starting osteoporosis treatment, 1 year later, the therapeutic window of opportunity has already closed.

Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women.

UNLABELLED: This study determined the cost of treating fractures at osteoporotic sites (except spine fractures) for the year following fracture. While the average cost of treating a hip fracture was the highest of all fractures ($46,664 CAD per fracture), treating other fractures also accounted for significant expenditures ($5,253 to $10,410 CAD per fracture). INTRODUCTION: This study aims to determine the mean direct medical cost of treating fractures at peripheral osteoporotic sites in the year post-fracture (through 2 years post-hip fracture). METHODS: Health administrative databases from the province of Quebec, Canada were used to estimate the cost of treating peripheral fractures at osteoporotic sites for the year following fracture (through 2 years for hip fractures). Included in costs analyses were physician claims, emergency and outpatient clinic costs, hospitalization costs, and subsequent costs for treatment of complications. RESULTS: A total of 15,827 patients (mean age 72 years) who suffered one fracture at an osteoporotic site had data for analyses. Hip/femur fractures had the highest rate of hospital stays related to fracture (91%) and the highest rate of hospital stays associated with a post-fracture complication (8%). In the year following fracture, the mean (SD) costs (2009 Canadian dollars) of treating acute fractures and post-fracture complications were: hip/femur fracture $46,664 ($43,198), wrist fracture $5,253 ($18,982), and fractures at other peripheral sites $10,410 ($27,641). The average (SD) cost of treating post-fracture complications at the hip/femur in the second year post-fracture was $1,698 ($12,462). Hospitalizations associated with the fracture accounted for 88% of the total cost of fracture treatment. CONCLUSIONS: The treatment of hip fractures accounts for a significant proportion of the costs associated with the treatment of peripheral osteoporotic fractures. Interventions to reduce the incidence of fractures, particularly hip fractures, would result in significant cost savings to the health care system and would preserve quality of life in many patients.

The Effects of exclusive versus non-eclusive breastfeeding on specific infant morbidities in Conakry (Guinea)

Background :This study examines the effect of exclusive versus non-exclusive breastfeeding on specific infant morbidities from birth to nine months; in Conakry (Guinea). Method: A cross-sectional study was conducted on 1;167 mother-infant pairs who visited one of 20 immunization centres in Conakry for vaccination between the 45th and 270th days of the child's life. Two data sources were used: the infant health book and an orally administered questionnaire completed with the mother. Data analyses included univariate cross-tabulations and multivariate logistic regression models to estimate the effect of breastfeeding on infant morbidity. Results : Exclusive breastfeeding decreased with the infant's age. At six months of age; the proportion of infants who were exclusively breastfed was only 15.5. After adjusting for the infant's age; and the interaction between the type of breastfeeding and the infant's age; exclusive breastfeeding significantly protected the infants against many of the studied morbidities (OR: 0.28; CI: 0.15-0.51) and specifically against diarrhoea (OR: 0.38; 95CI: 0.17 - 0.86); respiratory infections (OR: 0.27; 95CI: 0.14 - 0.50); and low growth rate (OR: 0.11; 95CI: 0.02 - 0.46); but not for otitis; urinary infection; or meningitis. This investigation confirmed the protective effects of exclusive breastfeeding on some specific infant's morbidities during the first nine months of life. The results of this study are of great importance for the development of an information program designed to encourage the exclusive breastfeeding among the mothers of Conakry; Guinea