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Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis

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Abstract

Most people presenting with incident osteoporotic fractures are neither assessed nor treated for osteoporosis to reduce their risk of further fractures, despite the availability of effective treatments. We evaluated the effectiveness of published models of care for the secondary prevention of osteoporotic fractures. We searched eight medical literature databases to identify reports published between 1996 and 2011, describing models of care for secondary fracture prevention. Information extracted from each publication included study design, patient characteristics, identification strategies, assessment and treatment initiation strategies, as well as outcome measures (rates of bone mineral density (BMD) testing, osteoporosis treatment initiation, adherence, re-fractures and cost-effectiveness). Meta-analyses of studies with valid control groups were conducted for two outcome measures: BMD testing and osteoporosis treatment initiation. Out of 574 references, 42 articles were identified as analysable. These studies were grouped into four general models of care—type A: identification, assessment and treatment of patients as part of the service; type B: similar to A, without treatment initiation; type C: alerting patients plus primary care physicians; and type D: patient education only. Meta-regressions revealed a trend towards increased BMD testing (p = 0.06) and treatment initiation (p = 0.03) with increasing intensity of intervention. One type A service with a valid control group showed a significant decrease in re-fractures. Types A and B services were cost-effective, although definition of cost-effectiveness varied between studies. Fully coordinated, intensive models of care for secondary fracture prevention are more effective in improving patient outcomes than approaches involving alerts and/or education only.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Bone Research Program, ANZAC Research Institute, The University of Sydney, Concord, NSW, 2139, Australia

    K. Ganda & M. J. Seibel

  2. Public Health Unit-Hornsby Office, Hornsby Ku-ringai Hospital, Hornsby, NSW, Australia

    M. Puech

  3. Institute of Bone and Joint Research, The University of Sydney, Sydney, Australia

    J. S. Chen & L. March

  4. Musculoskeletal Network, Agency for Clinical Innovation, Chatswood, NSW, Australia

    R. Speerin

  5. Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    J. Bleasel

  6. Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia

    J. R. Center & J. A. Eisman

  7. St Vincent’s Hospital Clinical School, The University of New South Wales, Sydney, Australia

    J. A. Eisman

  8. School of Medicine, The University of Notre Dame, Sydney, Australia

    J. A. Eisman

  9. Department of Endocrinology, St Vincent’s Hospital, Sydney, Australia

    J. A. Eisman

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  1. K. Ganda
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Ganda, K., Puech, M., Chen, J.S. et al. Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24, 393–406 (2013). https://doi.org/10.1007/s00198-012-2090-y

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