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Fracture Prevalence and Treatment with Bone-Sparing Agents: Are There Urban-Rural Differences?
A Population Based Study in Ontario, Canada
SUZANNE M. CADARETTE, SUSAN B. JAGLAL, and GILLIAN A. HAWKER
ABSTRACT. Objective. To estimate the prevalence of self-reported osteoporotic fractures and use of bone-sparing agents, and to examine if region of residence is associated with fracture or treatment prevalence. Methods. A census of persons aged ≥ 55 years residing in 2 regions of Ontario, Canada (East York, a region within Toronto, and Oxford County), was completed between 1995 and 1998. Region was coded by record linkage of residential postal codes to 1996 Canadian Census data into 4 groups: East York (urban core), and Oxford County subdivided into: urban core, small urban, and rural. Respondents were excluded if they resided outside the regions of interest or were missing fracture data (5%). Results. A total of 26,839 persons (15,541 women) were studied. Nearly 3 times as many women as men reported having had an osteoporotic fracture (14% vs 5%), with 31% and 8%, respectively, taking bone-sparing agents. Controlling for age, a diagnosis of osteoporosis, number of osteoporotic fractures, and height loss, women residing in East York were more likely (OR 1.2, 95% CI 1.0–1.4) to be taking a bone-sparing agent other than estrogen, but less likely to be taking estrogen (OR 0.8, 95% CI 0.7–0.9) compared to those living in rural areas. No regional differences were observed in fracture prevalence, treatment among those with an osteoporotic fracture, or use of a bone-sparing agent among men. Conclusion. Further research into regional differences in osteoporosis screening, treatment, and fractures is warranted. This should examine the appropriateness of possible differences, and separate physician practice patterns from patient characteristics, such as willingness to begin treatment with bone-sparing agents. (J Rheumatol 2005;32:550-8)tab Key Indexing Terms:
DRUG THERAPY
From the Departments of Health Policy, Management and Evaluation, and Rehabilitation Science, University of Toronto; the Osteoporosis Research Program and Division of Rheumatology, Women's College Ambulatory Care Centre, Sunnybrook and Women's College Health Sciences Centre; and the Institute for Clinical Evaluative Sciences in Ontario, Toronto, Ontario, Canada. Supported by the Department of Medicine, Sunnybrook and Women's College Ambulatory Care Centre, and by an unrestricted educational research grant from Procter & Gamble/Aventis Pharmaceuticals, Canada. The Study of Arthritis in Your Community was funded by the Medical Research Council of Canada (MT-12919), The Arthritis Society (97-083), Physicians' Services Foundation (95-47), the Canadian Orthopaedic Foundation, and the University of Toronto Dean's Fund (00026896). S.M. Cadarette is supported by a Doctoral Research Award from the Canadian Institutes of Health Research (CIHR) in partnership with the Ontario Ministry of Health and Long-Term Care (OMHLTC), and a Naomi Grigg Fellowship for Post-Graduate Studies in Gerontology from the Soroptimist International of Toronto. Dr. Jaglal is a Scientist of the OMHLTC and Dr. Hawker is a CIHR Scientist. S.M. Cadarette, MSc, Department of Health Policy, Management and Evaluation, University of Toronto, Osteoporosis Research Program, Women's College Ambulatory Care Centre; S.B. Jaglal, PhD, Osteoporosis Research Program, Women's College Ambulatory Care Centre, Graduate Department of Rehabilitation Science, University of Toronto, Institute for Clinical Evaluative Sciences in Ontario; G.A. Hawker, MD, MSc, Department of Health Policy, Management and Evaluation, University of Toronto, Osteoporosis Research Program, Division of Rheumatology, Women's College Ambulatory Care Centre. Address reprint requests to S.M. Cadarette, Osteoporosis Research Program, Women's College Ambulatory Care Centre, Sunnybrook and Women's College Health Sciences Centre, 76 Grenville Street, Toronto, Ontario M5S 1B2. E-mail: s.cadarette@utoronto.ca Submitted April 21, 2004; revision accepted November 15, 2004. |