Original Artic le

Osteoporosis International

, 19:1733

First online:

A multifaceted intervention to improve treatment of osteoporosis in postmenopausal women with wrist fractures: a cluster randomized trial

  • A. CranneyAffiliated withClinical Epidemiology Program, Ottawa Health Research Institute, and Department of Medicine, University of OttawaClinical Epidemiology Program, Ottawa Health Research Institute Email author 
  • , M. LamAffiliated withDepartments of Medicine, Community Health and Epidemiology, Queen’s University
  • , L. RuhlandAffiliated withDepartment of Medicine, Queen’s University
  • , R. BrisonAffiliated withDepartments of Medicine, Community Health and Epidemiology, Queen’s UniversityDepartments of Emergency Medicine and Family Medicine, Queen’s University
  • , M. GodwinAffiliated withPrimary Healthcare Research Unit, Memorial University
  • , M. M. HarrisonAffiliated withHuman Mobility Research Centre and Department of Orthopedic Surgery, Queen’s University
  • , M. B. HarrisonAffiliated withSchool of Nursing, Queen’s University
  • , T. AnastassiadesAffiliated withDepartment of Medicine, Queen’s UniversityHuman Mobility Research Centre and Division of Rheumatology, Queen’s University
  • , J. M. GrimshawAffiliated withClinical Epidemiology Program, Ottawa Health Research Institute, and Department of Medicine, University of Ottawa
    • , I. D. GrahamAffiliated withClinical Epidemiology Program, Ottawa Health Research Institute, and Department of Medicine, University of OttawaFaculty of Health Sciences, University of Ottawa

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Abstract

Summary

In a cluster randomized trial, we evaluated the effect of a multifaceted intervention (directed at both patient and primary care physician) on the rates of testing and treatment of osteoporosis in postmenopausal women within six months of their wrist fracture. Compared to usual care, women in the intervention practices were three times more likely to receive bone mineral density testing and prescribed osteoporosis treatments.

Introduction

Postmenopausal women with wrist fractures are at increased risk of future fragility fractures, yet they frequently do not receive evaluation and treatment for osteoporosis. We set out to evaluate a multifaceted intervention designed to improve management of osteoporosis in older women with recent wrist fractures.

Methods

Cluster randomized trial of 270 women cared for in 119 primary care practices. We recruited postmenopausal women with an acute wrist fracture from the emergency departments of hospitals in southeastern Ontario, Canada. Family practices were randomly assigned to either the intervention or usual care. The intervention consisted of a mailed reminder with a summary of treatment guidelines and letter sent to the primary care physician, in addition to an educational package and letter to the women. The primary outcome was the proportion of women prescribed osteoporosis therapy within 6 months of their fracture.

Results

The mean age of women was 69(10.9) years. The intervention increased the proportion of women started on osteoporosis medications (28% vs. 10%) of controls, adjusted OR 3.45, 95% CI, 1.58–7.56, p = 0.002) and the proportion who had a bone mineral density (BMD) test (53.3% vs. 26%) of controls, OR 3.38, 95% CI, 1.83–6.26, p < 0.001). In addition to the intervention, having a female physician was a predictor of increased testing and treatment rates.

Conclusion

A multifaceted intervention significantly improved rates of osteoporosis treatment and BMD testing in postmenopausal women with wrist fractures.

Keywords

Cluster randomized trial Multifaceted intervention Osteoporosis Wrist fractures