Osteoporotic Fracture Guidelines and Medical Education Related to the Clinical Practices: A Nationwide Survey in China

Abstract

Objectives: To investigate the knowledge and practices of Chinese doctors in the management of osteoporotic fractures after the Chinese osteoporotic fracture guidelines update and aseries of medical education in 2017.

Methods: This was a cross-sectional survey of doctors in 71 cities across Mainland China. Based on the 2017 Chinese guidelines for the diagnosis and treatment of osteoporotic fractures, a questionnaire was designed and pre-tested for reliability and validity. Doctors were surveyed with the questionnaire after scientific meetings during February 2017 to January 2018 through WeChat or conference digital platforms or in paper form. Descriptive statistics was used to analyze the responses to the questionnaire.

Results: Overall, 314 valid questionnaires were confirmed. Regarding diagnosis, 77% agreed that osteoporosis could be diagnosed once an osteoporotic fracture occurred; 83% believed that the bone mineral density criteria for osteoporosis diagnosis would be T ≤ -2.5 SD. For treatment, almost all (99.7%) agreed with anti-osteoporosis treatment being one of the basic principles of osteoporotic fracture treatment; 71.6% considered bisphosphonates as the most commonly used anti-osteoporosis drug; 97% believed that patients who have used anti-osteoporosis drugs should reassess osteoporosis after osteoporotic fractures instead of discontinue; 95% thought that the patients who did not use anti-osteoporosis medications before osteoporotic fracture should be treated with anti-osteoporosis drugs after fracture treatment as early as possible; 89% agreed that the standard use of bisphosphonates after osteoporotic fracture would not affect bone healing adversely; 59% believed the course of bisphosphonates treatment for osteoporosis would be 3-5 years, and 27% considered it to be 1-3 years. The patient follow-up rate was poor: 46% selected follow-up rate <30%; only 20% selected follow-up rate >50%. Only 31% of the hospitals had long-term management programs for osteoporotic fractures.

Conclusions: Doctors generally adhered to the updated Chinese guidelines for osteoporotic fractures; frequent participation in medical education can help doctors to increase their awareness of osteoporosis as well as their acceptance and practice of the guidelines.

Keywords: Chinese osteoporotic fracture guidelines; Medical education; Osteoporotic fracture; Questionnaire survey.

Figure 1

Responses to Q1 (Do you agree that osteoporosis can be diagnosed clinically by the occurrence of fragility fractures?). (A) Overall analysis; (B) analysis by frequency of medical education; (C) analysis by job title.

Figure 2

The most prescribed daily dosages of calcium and vitamin D.

Figure 3

The most prescribed anti‐osteoporosis drugs.

Figure 4

The knowledge on timing of anti‐osteoporosis medication.

Figure 5

Recommended duration of bisphosphonates treatment. (A) Overall analysis; (B) analysis by frequency of attending medical education; and (C) analysis by job title.

Figure 6

Follow‐up rate of patients with osteoporotic fracture. Group A: doctors from hospitals with long‐term management program; Group B: doctors from hospitals without long‐term management program; Group C: doctors from hospitals with long‐term management programs at planning or preparatory stage.

Figure 7

Responses to Q11 (Do you agree that standardized use of bisphosphonates after osteoporotic fractures would not adversely affect fracture healing?), comparing with the data published in 2016.

Figure 8

The knowledge on duration of bisphosphonates treatment, comparing with the data published in 2016.