Table 4.
Responses to Knowledge Questions by Medical Specialty
| Item no. | Topic | Response a | Prevalence of selecting response (n [%]) | p Value b | |||
|---|---|---|---|---|---|---|---|
| Overall sample (n = 579) | Family medicine (n = 182; 31.4%) | Internal medicine (n = 275; 47.5%) | OB/GYN (n = 122; 21.1%) | ||||
| 1 | T‐score threshold for diagnosis of osteoporosis | T‐score ≤ −2.5 | 445 (77%) | 137 (75%) | 215 (78%) | 93 (76%) | 0.76 |
| T‐score < −1 | 8 (1%) | 4 (2%) | 1 (0%) | 3 (2%) | |||
| Z‐score < −1 | 1 (0%) | 0 (0%) | 0 (0%) | 1 (1%) | |||
| Z‐score < −2.5 | 124 (21%) | 41 (23%) | 59 (21%) | 24 (20%) | |||
| Missing | 1 (0%) | 0 (0%) | 0 (0%) | 1 (1%) | |||
| 2 | Prevalence of osteoporosis‐related fractures in older women | 10% | 127 (22%) | 35 (19%) | 47 (17%) | 45 (37%) | |
| 20% | 363 (63%) | 120 (66%) | 172 (63%) | 71 (58%) | |||
| 50% | 87 (15%) | 27 (15%) | 54 (20%) | 6 (5%) | <0.001 | ||
| Missing | 2 (0%) | 0 (0%) | 2 (1%) | 0 (0%) | |||
| 3 | Mortality after hip fracture | Greater in women than in men | 374 (65%) | 114 (63%) | 159 (58%) | 101 (83%) | |
| Greater in men than in women | 58 (10%) | 17 (9%) | 34 (12%) | 7 (6%) | 0.12 | ||
| Equal in men and women | 146 (25%) | 51 (28%) | 81 (29%) | 14 (11%) | |||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 4 | Proportion of hip fracture patients who regain pre‐fracture level of independence | 5% | 184 (32%) | 52 (29%) | 92 (33%) | 40 (33%) | |
| 20% | 273 (47%) | 89 (49%) | 125 (45%) | 59 (48%) | |||
| 40% | 121 (21%) | 41 (23%) | 57 (21%) | 23 (19%) | 0.74 | ||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 5 | Age to begin routine bone density screening in women (United States Preventive Services Task Force) | When they begin their menopausal transition | 10 (2%) | 6 (3%) | 4 (1%) | 0 (0%) | |
| One year after the menopausal transition | 32 (6%) | 9 (5%) | 22 (8%) | 1 (1%) | |||
| At age 65 years | 470 (81%) | 148 (81%) | 207 (75%) | 115 (94%) | <0.001 | ||
| At age 50 years | 66 (11%) | 19 (10%) | 41 (15%) | 6 (5%) | |||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 6 | Osteoporosis screening in men (United States Preventive Services Task Force) | Screen beginning at age 50 years | 11 (2%) | 2 (1%) | 7 (3%) | 2 (2%) | |
| Screen beginning at age 70 years | 75 (13%) | 12 (7%) | 41 (15%) | 22 (18%) | |||
| Insufficient evidence to recommend for or against screening | 431 (74%) | 152 (84%) | 195 (71%) | 84 (69%) | 0.003 | ||
| None of the above | 61 (11%) | 16 (9%) | 31 (11%) | 14 (11%) | |||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 7 | Minimal‐trauma hip fracture is diagnostic of osteoporosis | Osteoporosis | 116 (20%) | 29 (16%) | 66 (24%) | 21 (17%) | 0.07 |
| Osteopenia | 39 (7%) | 13 (7%) | 18 (7%) | 8 (7%) | |||
| Unclear, requires further studies | 423 (73%) | 140 (77%) | 190 (69%) | 93 (76%) | |||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 8 | Osteoporosis medications demonstrated in clinical trials to decrease hip fracture risk | Calcitonin | 31 (5%) | 15 (8%) | 10 (4%) | 6 (5%) | |
| Raloxifene | 226 (39%) | 66 (36%) | 83 (30%) | 77 (63%) | |||
| Abaloparatide | 108 (19%) | 33 (18%) | 57 (21%) | 18 (15%) | |||
| None of the above | 213 (37%) | 68 (37%) | 124 (45%) | 21 (17%) | <0.001 | ||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 9 | First‐line therapy for osteoporosis (American College of Physicians guidelines) | Raloxifene | 138 (24%) | 47 (26%) | 40 (15%) | 51 (42%) | |
| Estrogen therapy | 29 (5%) | 5 (3%) | 17 (6%) | 7 (6%) | |||
| Calcitonin | 26 (4%) | 7 (4%) | 12 (4%) | 7 (6%) | |||
| None of the above | 385 (66%) | 123 (68%) | 205 (75%) | 57 (47%) | <0.001 | ||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 10 | Optimal duration of osteoporosis pharmacotherapy | Optimal duration of treatment is unclear | 362 (63%) | 118 (65%) | 165 (60%) | 79 (65%) | 0.49 |
| Treatment duration is usually 10 years | 96 (17%) | 22 (12%) | 52 (19%) | 22 (18%) | |||
| Adverse effects are not duration‐dependent | 41 (7%) | 10 (5%) | 25 (9%) | 6 (5%) | |||
| None of the above | 78 (13%) | 32 (18%) | 31 (11%) | 15 (12%) | |||
| Missing | 2 (0%) | 0 (0%) | 2 (1%) | 0 (0%) | |||
| 11 | Drug holiday definition | A switch from one osteoporosis medication to another | 8 (1%) | 1 (1%) | 6 (2%) | 1 (1%) | |
| A temporary discontinuation of pharmacotherapy | 443 (77%) | 151 (83%) | 199 (72%) | 93 (76%) | 0.03 | ||
| All of the above | 127 (22%) | 30 (16%) | 69 (25%) | 28 (23%) | |||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 12 | Most rapid bone density decline after discontinuation | Denosumab | 229 (40%) | 48 (26%) | 152 (55%) | 29 (24%) | <0.001 |
| Risedronate | 79 (14%) | 33 (18%) | 29 (11%) | 17 (14%) | |||
| Alendronate | 266 (46%) | 101 (55%) | 90 (33%) | 75 (61%) | |||
| Missing | 5 (1%) | 0 (0%) | 4 (1%) | 1 (1%) | |||
| 13 | Medications associated with osteonecrosis of the jaw | Denosumab | 106 (18%) | 37 (20%) | 45 (16%) | 24 (20%) | |
| Alendronate | 386 (67%) | 122 (67%) | 178 (65%) | 86 (70%) | |||
| All of the above | 86 (15%) | 23 (13%) | 51 (19%) | 12 (10%) | 0.047 | ||
| Missing | 1 (0%) | 0 (0%) | 1 (0%) | 0 (0%) | |||
| 14 | Characteristics of bisphosphonate‐associated atypical femoral fractures | They are associated with use of raloxifene | 48 (8%) | 15 (8%) | 27 (10%) | 6 (5%) | |
| They are duration‐dependent | 245 (42%) | 75 (41%) | 115 (42%) | 55 (45%) | 0.78 | ||
| They occur in 10% of patients | 156 (27%) | 53 (29%) | 72 (26%) | 31 (25%) | |||
| None of the above | 125 (22%) | 38 (21%) | 57 (21%) | 30 (25%) | |||
| Missing | 5 (1%) | 1 (1%) | 4 (1%) | 0 (0%) | |||
a
Boldface indicates correct responses.
b
The p values are calculated using chi‐square tests for comparison of correct answers between family medicine, internal medicine, and OB/GYN residents.