Development of a gender score and its association with treatment outcomes in fragility fracture patients screened through Ontario’s Fracture Screening and Prevention Program

Summary: We developed and validated a gender score using data from Ontario’s Fracture Screening and Prevention Program and assessed its association with treatment outcomes. Individuals with higher scores exhibited female-like characteristics and were more likely to receive medication prescriptions in the program. Tailored interventions addressing both sex and gender are needed to improve post-fracture care outcomes within the program. Purpose: To develop and validate a gender score using data from Ontario’s Fracture Screening and Prevention Program (FSPP) and to evaluate its association with treatment outcomes, including medication prescription and initiation, in patients at high risk for future fractures. Methods: A retrospective cohort study was conducted to examine the association between gender score and treatment outcomes in high risk patients who were screened through the FSPP between July 1, 2017, and June 30, 2023. A gender score was constructed using a propensity scoring method, with sex serving as the dependent variable in a multivariable logistic regression model. The gender-related variables were identified from the FSPP dataset. The study also evaluated the face and construct validity of the derived gender score. Multivariable logistic regression was conducted to examine the association between the derived gender score and treatment outcomes. Results: Among the 45,135 patients screened through the FSPP, 19,278 patients had complete data for gender-related variables included in the derivation of a gender score. Seven out of eight gender-related variables were found to have associations with sex. The derived gender score demonstrated moderate predictive accuracy, with higher scores indicating higher feminine characteristics. Patients with higher feminine characteristics were significantly more likely to receive a medication prescription within the program. Conclusion: We applied and validated a method to create a gender score using FSPP data and validated the score by demonstrating both face and construct validity. The findings of this study highlight the importance of considering gender-related variables in healthcare delivery, particularly within secondary fracture prevention programs. By examining the influence of gender on treatment outcomes, this study provides valuable insights for developing tailored interventions that address the diverse needs of patients and improve overall care and long-term outcomes.