Compton M1, Mortenson WB2,3, Sale J4,5, Crossman A6, Ashe MC7,8,9
1National University of Ireland, Galway, Ireland, 2University of British Columbia, Occupational Therapy, Vancouver, Canada, 3International Collaboration or Repair Discoveries and Rehabilitation Research Program, Vancouver, Canada, 4Li Ka Shing Knowledge Institute, Toronto, Canada, 5University of Toronto, Toronto, Canada, 6Royal Melbourne Hospital, Melbourne, Australia, 7University of British Columbia, Family Practice, Vancouver, Canada, 8Centre for Hip Health and Mobility, Vancouver, Canada, 9The University of Adelaide, Psychology, Adelaide, Canada
Background: One in five men will experience an osteoporosis-related fracture in their lifetime. However, osteoporosis is widely perceived as a women's disease and few studies focus specifically on men. To move forward in developing prevention and management strategies that are acceptable to men, it is important to synthesize available evidence on men's perceptions of bone health and low-trauma fracture.
Purpose: Our objective was to identify qualitative evidence to understand men's perceptions of osteoporosis and fracture.
Methods: We conducted a systematic review following standardized guidelines. Prior to starting the process, we registered the title and methods on PROSPERO CRD42018093999. We identified qualitative studies that included men aged 18 years+ using the terms: osteoporosis, fragility or low-trauma fracture, bone health; and perceptions or experiences with osteoporosis and fractures. We searched the following electronic databases for all years: Ageline, Anthropology Plus, Biomedical Reference Collection, CINAHL Complete, Embase, Humanities and Social Sciences, Index Retrospective, MEDLINE (Ovid), PsycArticles, PsycINFO, and SportDiscus. We used Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia) to remove duplicates and track information for creating a flow diagram. For all studies included at the full text level, we conducted a forward citation search, and reviewed their reference lists. We included literature from all years and in all languages. We appraised the quality of data using the Critical Appraisal Skills Programme Checklist. We used the Joanna Briggs Institute's meta-aggregative approach to synthesize findings: One author extracted themes and quotes from all included studies, and two authors reviewed quotes and then together sorted them into similar categories to develop synthesized findings (concept mapping).
Results: We identified four publications and three studies (n=61 participants): one study was a secondary analysis of several studies. Emerging themes included:
(1) perceived healthcare gap for men;
(2) strong focus on women; need for support from spouses and health professionals; and
(3) three general responses to men's osteoporosis self-management: limiting lifestyle, minimizing importance of diagnosis, and risk taking. Relevant to physiotherapy was men's perceptions that either they should limit or reduce their physical activity (to avoid injury), or continue with at risk behaviors (e.g., climbing ladders).
Conclusion(s): The most significant finding from this review was the lack of available evidence. However, it emerged that the present focus of osteoporosis as a women's disease may influence how men develop self-management strategies. These data highlight the need to include men in future osteoporosis health-related conversations and interventions.
Implications: Given the number of men at midlife and older who have low bone mass and or sustain a low-trauma fracture, it is important to develop a more patient-centered approach for osteoporosis management. To address this gap, education and awareness of osteoporosis in men is key in achieving exemplary care. This includes the education of health providers (e.g., primary care physicians, physiotherapists and other community-based health providers) and society, in general.
Keywords: men's bone health, systematic review, qualitative research
Funding acknowledgements: The study was unfunded.
Purpose: Our objective was to identify qualitative evidence to understand men's perceptions of osteoporosis and fracture.
Methods: We conducted a systematic review following standardized guidelines. Prior to starting the process, we registered the title and methods on PROSPERO CRD42018093999. We identified qualitative studies that included men aged 18 years+ using the terms: osteoporosis, fragility or low-trauma fracture, bone health; and perceptions or experiences with osteoporosis and fractures. We searched the following electronic databases for all years: Ageline, Anthropology Plus, Biomedical Reference Collection, CINAHL Complete, Embase, Humanities and Social Sciences, Index Retrospective, MEDLINE (Ovid), PsycArticles, PsycINFO, and SportDiscus. We used Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia) to remove duplicates and track information for creating a flow diagram. For all studies included at the full text level, we conducted a forward citation search, and reviewed their reference lists. We included literature from all years and in all languages. We appraised the quality of data using the Critical Appraisal Skills Programme Checklist. We used the Joanna Briggs Institute's meta-aggregative approach to synthesize findings: One author extracted themes and quotes from all included studies, and two authors reviewed quotes and then together sorted them into similar categories to develop synthesized findings (concept mapping).
Results: We identified four publications and three studies (n=61 participants): one study was a secondary analysis of several studies. Emerging themes included:
(1) perceived healthcare gap for men;
(2) strong focus on women; need for support from spouses and health professionals; and
(3) three general responses to men's osteoporosis self-management: limiting lifestyle, minimizing importance of diagnosis, and risk taking. Relevant to physiotherapy was men's perceptions that either they should limit or reduce their physical activity (to avoid injury), or continue with at risk behaviors (e.g., climbing ladders).
Conclusion(s): The most significant finding from this review was the lack of available evidence. However, it emerged that the present focus of osteoporosis as a women's disease may influence how men develop self-management strategies. These data highlight the need to include men in future osteoporosis health-related conversations and interventions.
Implications: Given the number of men at midlife and older who have low bone mass and or sustain a low-trauma fracture, it is important to develop a more patient-centered approach for osteoporosis management. To address this gap, education and awareness of osteoporosis in men is key in achieving exemplary care. This includes the education of health providers (e.g., primary care physicians, physiotherapists and other community-based health providers) and society, in general.
Keywords: men's bone health, systematic review, qualitative research
Funding acknowledgements: The study was unfunded.
Topic: Musculoskeletal; Disability & rehabilitation
Ethics approval required: No
Institution: UBC
Ethics committee: REB
Reason not required: It was a systematic review of the literature.
All authors, affiliations and abstracts have been published as submitted.
