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Improving osteoporosis management in patients with fractures

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Abstract

A history of fracture is an independent risk factor for future fractures, but patients who have sustained a fracture are rarely evaluated for osteoporosis (OP). The objective of this study was to determine if a simple intervention in a general orthopedic clinic would lead to more fracture patients receiving evaluation and treatment for OP. Patients with a history of fracture visiting a weekly orthopedic clinic during a 6-month intervention period were educated about OP, and a bone mineral density (BMD) test was offered. The number of BMD tests performed and other OP-specific actions taken as a result of the intervention were compared with a 6-month pre-intervention period. The prevalence of OP in those who underwent BMD testing was examined. In the pre-intervention period, only 12.7% (16 of 126) had a BMD test as compared with 62.5% of the 136 intervention-period subjects (odds ratio [OR] 11.5, 95% confidence interval [CI] 6.1, 21.4). Based on BMD test results, 11.9% of the pre-intervention patients, and 41.9% of the intervention patients received OP-specific recommendations (OR 5.3, 95% CI 2.8, 10.1). The intervention led to more patients being treated for low bone mass (9.5% vs 23.5%); OR 2.9, 95% CI 1.4, 5.9. Low bone mass was common among all types of fracture patients: 20% had osteoporosis and 41%, osteopenia. BMD testing in patients with fractures should identify those at risk for future fractures, leading to appropriate treatment.

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References

  1. Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD (2003) Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: The OFELY Study. Bone 32:78–85

    Article  CAS  PubMed  Google Scholar 

  2. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828

    CAS  PubMed  Google Scholar 

  3. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773

    Article  CAS  PubMed  Google Scholar 

  4. Gunnes M, Mellstrom D, Johnell O (1998) How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal women. Acta Orthop Scand 69:508–512

    CAS  PubMed  Google Scholar 

  5. Kanis J, Johnell O, Gullberg B, Allander E, Elffors L, Ranstam J, Dequeker J, Dilsen G, Gennari C, Vaz AL, Lyritis G, Mazzuoli G, Miravet L, Passeri M, Perez CR, Rapado A, Ribot C (1999) Risk factors for hip fracture in men from southern Europe: the MEDOS study. Osteoporos Int 9:45–54

    Article  CAS  PubMed  Google Scholar 

  6. Karlsson MK, Hasserius R, Obrant KJ (1993) Individuals who sustain nonosteoporotic fractures continue to also sustain fragility fractures. Calcif Tissue Int 53:229–231

    CAS  PubMed  Google Scholar 

  7. Wu F, Mason B, Horne A, Ames R, Clearwater J, Liu M, Evans MC, Gamble GD, Reid IR (2002) Fractures between the ages of 20 and 50 years increase women’s risk of subsequent fractures. Arch Intern Med 162:33–36

    Article  PubMed  Google Scholar 

  8. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739

    CAS  PubMed  Google Scholar 

  9. Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O’Fallon WM, Melton LJ 3rd (2002) Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med 162:421–426

    Article  PubMed  Google Scholar 

  10. Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82:1063–1070

    Google Scholar 

  11. Harrington JT, Broy SB, Derosa AM, Licata AA, Shewmon DA (2002) Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum 47:651–654

    Article  PubMed  Google Scholar 

  12. Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE (2000) Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture 26. Am J Med 109:326–328

    Article  CAS  PubMed  Google Scholar 

  13. Riley RL, Carnes ML, Gudmundsson A, Elliott ME (2002) Outcomes and secondary prevention strategies for male hip fractures. Ann Pharmacother 36:17–23

    Article  PubMed  Google Scholar 

  14. Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S

    CAS  Google Scholar 

  15. Johnell O (1997) The socioeconomic burden of fractures: today and in the 21st century. Am J Med 103:20S–25S

    Article  CAS  PubMed  Google Scholar 

  16. Siris ES, Bilezikian JP, Rubin MR, Black DM, Bockman RS, Bone HG, Hochberg MC, McClung MR, Schnitzer TJ (2003) Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab 88:3482–3486

    Article  CAS  PubMed  Google Scholar 

  17. Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12:1761–1768

    CAS  PubMed  Google Scholar 

  18. Hamdy RC, Petak SM, Lenchik L (2002) Which central dual X-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis? J Clin Densitom 5 [Suppl]:S11–S18

  19. The Writing Group for the International Society for Clinical Densitometry (ISCD) Position Development Conference (2004) Position statement: executive summary. J Clin Densitom. 7:7–12

    Google Scholar 

  20. Hawker G, Ridout R, Ricupero M, Jaglal S, Bogoch E (2003) The impact of a simple fracture clinic intervention in improving the diagnosis and treatment of osteoporosis in fragility fracture patients. Osteoporos Int 14:171–178

    PubMed  Google Scholar 

  21. Feldstein AC, Elmer PJ, Smith DH, Aickin M, Herson MK, Orwoll ES, Chen C, Swain MC (2003) Results of a randomized controlled trial to improve the management of osteoporosis after fracture. J Bone Miner Res 18 [Suppl 2]:SU367

  22. Newman ED, Ayoub WT, Starkey RH, Diehl JM, Wood GC (2003) Osteoporosis disease management in a rural health care population: hip fracture reduction and reduced costs in postmenopausal women after 5 years. Osteoporos Int 14:146–151

    CAS  PubMed  Google Scholar 

  23. Adler RA, Tran MT, Petkov VI (2003) Performance of the osteoporosis self-assessment screening tool for osteoporosis in American men. Mayo Clin Proc 78:723–727

    PubMed  Google Scholar 

  24. Williams MI, Petkov VI, Johnson SL, Wright S, Tran MT, Adler RA (2003) Applying the osteoporosis self-assessment tool (OST) in primary care clinics uncovers osteoporosis in men. J Bone Miner Res 18 [Suppl 2]:S154

  25. Jaglal SB, McIsaac WJ, Hawker G, Carroll J, Jaakkimainen L, Cadarette SM, Cameron C, Davis D (2003) Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporos Int 14:672–676

    Article  PubMed  Google Scholar 

  26. Simonelli C, Killeen K, Mehle S, Swanson L (2002) Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc 77:334–338

    PubMed  Google Scholar 

  27. Vallarta-Ast N, Krueger D, Binkley N (2002) Densitometric diagnosis of osteoporosis in men: effect of measurement site and normative database. J Clin Densitom 5:383–389

    Article  PubMed  Google Scholar 

  28. Melton LJ 3rd, Atkinson EJ, O’Connor MK, O’Fallon WM, Riggs BL (1998) Bone density and fracture risk in men. J Bone Miner Res 13:1915–1923

    PubMed  Google Scholar 

  29. Petkov VI, Williams MI, Via PS, Hodson T, Adler RA (2004) Dual energy X-ray absorptiometry (DXA) of the forearm in men: radius versus total. J Bone Miner Res 19 [Suppl 1]:SU125

  30. Bruder JM (2004) Diagnosis of osteoporosis by the radius DXA—do we know the best site? J Clin Densitom 7:242

    Google Scholar 

  31. Pazirandeh M (2002) Does patient partnership in continuing medical education (CME) improve the outcome in osteoporosis management? J Contin Educ Health Prof 22:142–151

    PubMed  Google Scholar 

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Acknowledgements

We thank the staff of the McGuire VAMC Wednesday Orthopedic Clinic for their help and support. This study was supported in part by an unrestricted grant from Procter & Gamble

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Authors and Affiliations

  1. Endocrinology Section, McGuire Veterans Affairs Medical Center, Richmond, VA, USA

    S. L. Johnson, M. I. Williams, P. S. Via & Robert A. Adler

  2. Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA

    S. L. Johnson & M. I. Williams

  3. McGuire Research Institute Inc., Richmond, VA, USA

    V. I. Petkov

  4. Department of Preventive Medicine and Community Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    V. I. Petkov & Robert A. Adler

  5. Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA

    Robert A. Adler

  6. McGuire VAMC (111P), Richmond, VA, 23249, USA

    Robert A. Adler

Authors
  1. S. L. Johnson
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  2. V. I. Petkov
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  3. M. I. Williams
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  4. P. S. Via
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  5. Robert A. Adler
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Correspondence to Robert A. Adler.

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Johnson, S.L., Petkov, V.I., Williams, M.I. et al. Improving osteoporosis management in patients with fractures. Osteoporos Int 16, 1079–1085 (2005). https://doi.org/10.1007/s00198-004-1814-z

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  • DOI: https://doi.org/10.1007/s00198-004-1814-z

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