Survey on Awareness, Knowledge and Practices: Managing Osteoporosis among Practitioners in a Tertiary Hospital, Malaysia

This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.





References:
[1] Tümay Sözen, Lale Özışık, and Nursel Çalık Başaran. An overview and management of osteoporosis. Eur J Rheumatol. 2017 Mar; 4(1): 46–56.
[2] Kristie N. Tu, Janette D. Lie, et al. Osteoporosis: A Review of Treatment Options. P&T. February 2018; 43 (2): 92-104.
[3] C Christodoulou, C Cooper. What is osteoporosis? Postgrad Med J 2003; 79:133–138.
[4] International Osteoporosis Foundation. https://www.iofbonehealth.org/facts-statistics
[5] Malaysian Osteoporosis Society. http://www.osteoporosis.my/
[6] https://www.thestar.com.my/lifestyle/health/2011/07/10/these-old-bones-of-mine#j0ezdpEuZXymBl44.99
[7] Catherine Burt Driver, Osteoporosis. Available in https://www.emedicinehealth.com/osteoporosis/article_em.htm
[8] I.A. Dontas and C.K. Yiannakopoulos. Risk factors and prevention of osteoporosis-related fractures. J Musculoskelet Neuronal Interact 2007; 7(3):268-272.
[9] Ralph E. Small. Uses and Limitations of Bone Mineral Density Measurements in the Management of Osteoporosis. Available in https://www.medscape.com/viewarticle/503801_3
[10] Kristie N. Tu, Janette D. Lie, Chew King Victoria Wan, et al. Osteoporosis: A Review of Treatment Options. Pharmacy & Therapeutics. 2018 Feb; 43(2): 92–104.
[11] AH Warriner, RC Outman, KG Saag, SD Berry, C Colón-Emeric, KL Flood, KW Lyles, SB Tanner, NB Watts, and JR Curtis. The Management of Osteoporosis among Home Health and Long Term Care Patients with a Prior Fracture. South Med J. 2009 April; 102(4): 397–404.
[12] Mohammed Yehia Saeedi, Fahd Al-Amri, Ashry Mohamed, Ahmed Khair Ibrahim. Knowledge, attitude and practice towards osteoporosis among primary health care physicians in Riyadh, Saudi Arabia. Science Journal of Public Health 2014; 2(6): 624-630.
[13] Chenot R., Scheidt-Nave C., Gabler S., Kochen M.M., Himmel W. German Primary Care Doctors’ Awareness of Osteoporosis and Knowledge of National Guidelines. Exp Clin Endocrinol Diabetes 2007; 115: 584– 589.
[14] Salem A. Beshyah, Wafa Al Mehri, Ali B. Khalil. Osteoporosis and Its Management: Knowledge, Attitudes and Practices of Physicians in United Arab Emirates. Ibnosina Journal of Medicine and Biomedical Sciences 2013, 5(5): 270-279.
[15] George Chami, Lee Jeys, Mathew Freudmann, Louise Connor and Mashood Siddiqi. Are osteoporotic fractures being adequately investigated?: A questionnaire of GP & orthopaedic surgeons. BMC Family Practice 2006, 7: 7.
[16] Perla Werner, Iris Vered Management of Osteoporosis: A Survey of Israeli Physicians’ Knowledge and Attitudes IMAJ 2000; 2: 361-364.
[17] Yong-Chan Ha, Young-Kyun Lee, Yong-Taik Lim, Sun-Mee Jang, Chan Soo Shin. Physicians’ Attitudes to Contemporary Issues on Osteoporosis Management in Korea. J Bone Metab 2014; 21: 143-150.
[18] Fogelman Y, Goldshtein I, Segal E, Ish-Shalom S. Managing Osteoporosis: A Survey of Knowledge, Attitudes and Practices among Primary Care Physicians in Israel. 2016. PLOS ONE. 11. e0160661. 10.1371/journal.pone.0160661.
[19] George Ioannidis, Alexandra Papaioannou, Lehana Thabane, Amiram Gafni, Anthony Hodsman, Brent Kvern, Aleksandra Walsh, Famida Jiwa and Jonathan D. Adachi. Family Physicians’ Personal and Practice Characteristics that Are Associated with Improved Utilization of Bone Mineral Density Testing and Osteoporosis Medication Prescribing. Popul Health Manag. 2009 Jun; 12(3): 131–138.
[20] Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Eugenio Quarta, Maurizio Muratore and Sergio Casciaro. Major osteoporotic fragility fractures: Risk factor updates and societal impact. World J Orthop 2016 March 18; 7(3): 171-181 ISSN 2218-5836
[21] Farkhondeh Pouresmaeili, Behnam Kamalidehghan, Maryam Kamarehei, Yong Meng Goh. A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag. 2018; 14: 2029–2049.
[22] Malaysia’s Clinical Practice Guidelines on Management of Osteoporosis 2012 (revised 2015).
[23] Bischoff-Ferrari HA, Willett WC, et al. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005 May 11; 293(18): 2257-64.
[24] Cumming RG, Nevitt MC. Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res. 1997 Sep; 12(9): 1321-9.
[25] John A Sunyecz. The use of calcium and vitamin D in the management of osteoporosis. Therapeutics and Clinical Risk Management 2008; 4(4): 827–836.
[26] Cummings SR, Black DM, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998 Dec 23-30; 280(24): 2077-82.
[27] Utian WH, Woods NF. Impact of hormone therapy on quality of life after menopause. Menopause 2013 Oct; 20(10): 1098-105. doi: 10.1097/GME.0b013e318298debe.
[28] Sarah Bedell Cook. Bioidentical Hormone Replacement Therapy in Postmenopausal Osteoporosis, Is BHRT the key to prevention? Natural Medicine Journal August 2014 Vol. 6 Issue 81.
[29] Jordan C. Villa, Arianna Gianakos and Joseph M. Lane. Bisphosphonate Treatment in Osteoporosis: Optimal Duration of Therapy and the Incorporation of a Drug Holiday. The Musculoskeletal Journal of Hospital for Special Surgery. 2016 Feb; 12(1): 66–73.
[30] Neuner JM, Schapira MM. The importance of physicians' risk perception in osteoporosis treatment decision making. J Clin Densitom 2012; 15: 49–54. 10.1016/j.jocd.2011.07.008
[31] Werner P, Vered I. Management of osteoporosis: a survey of Israeli physicians' knowledge and attitudes. Isr Med Assoc J 2000; 2: 361–4.
[32] Derbew Fikadu Berhe, Katja Taxis, et al. Healthcare professionals' level of medication knowledge in Africa: a systematic review. Br J Clin Pharmacol. 2018 Dec; 84(12): 2729–2746.
[33] Saqib A, Atif M, Ikram R, Riaz F, Abubakar M, Scahill S (2018) Factors affecting patients’ knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan. PLoS ONE 2018; 13(6): e0197482. https://doi.org/10.1371/journal.pone.0197482
[34] Malochet GuinamandS, ChalardN, BillaultC, BreuilN, RistoriJM, SchmidtJ. Osteoporosis treatment in post-menopausal women after peripheral fractures: impact of information to general practitioners. Joint Bone Spine 2005; 72: 562–6. PMID:15996502