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Addition of a fracture risk assessment to a coordinator’s role improved treatment rates within 6 months of screening in a fragility fracture screening program

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Abstract

Summary

We evaluated the impact of a more intensive version of an existing post-fracture coordinator-based fracture prevention program and found that the addition of a full-risk assessment improved treatment rates. These findings provide additional support for more intensive programs aimed at reducing the risk of re-fractures.

Introduction

Evidence-based guidelines support coordinator-based programs to improve post-fracture osteoporosis guideline uptake, with more intensive programs including bone mineral density (BMD) testing and/or treatment being associated with better patient outcomes. The purpose of this study was to evaluate the impact of a more intensive version (BMD “fast track”) of an existing provincial coordinator-based program.

Methods

We compared two versions of the program that screened treatment naïve fragility fracture patients (>50 years). Cases came from the BMD fast track program that included full fracture risk assessment and communication of relevant guidelines to the primary care provider (PCP). Matched controls were selected from the usual care program matching according to age, sex, fracture type, and date. Two matching techniques were used: traditional (hard) matching (TM) and propensity score matching (PS). The outcomes were treatment initiation with bone sparing medication, BMD testing rate, and the rate of returning to discuss the test results with a PCP.

Results

The program improvements led to a significant improvement in treatment initiation within 6 months from 16 % (controls based on PS) or 21 % (controls based on TM) to 32 % (cases). Ninety percent of patients in the BMD fast track program returned to their PCP to discuss bone health in the cases versus 60 % of the controls (for TM and PS). BMD testing occurred in 96 % of cases compared to the 66 (TM) or 65 % (PS) of the matched controls.

Conclusions

Addition of a full-risk assessment to a coordinator-based program significantly improved treatment rates within 6 months of screening.

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Acknowledgments

The authors would like to acknowledge the fracture prevention coordinators, the regional integration leads, and the staff of Osteoporosis Canada for their implementation of the program changes evaluated in this study and for their feedback on our evaluation results. We thank all the patients who are part of this program as well as their orthopedic surgeons and primary care providers. Finally, we acknowledge the other members of the Fracture Clinic Screening Program (FCSP) evaluation team who provided constant feedback and reflection on all of our common evaluative efforts.

This study has been supported through funding by the Ontario Ministry of Health and Long-Term Care through the Ontario Osteoporosis Strategy. The views expressed are those of the authors and do not necessarily reflect those of the ministry.

Author information

Authors and Affiliations

  1. Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada

    D. E. Beaton, R. Sujic, N. K. Rotondi & J. E. M. Sale

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    D. E. Beaton, K. B. Pitzul & J. E. M. Sale

  3. Analytics & Informatics: Access to Care, Cancer Care Ontario, Toronto, ON, Canada

    M. Vidmar

  4. Mobility Program, St. Michael’s Hospital, Toronto, ON, Canada

    E. R. Bogoch

  5. Department of Surgery, University of Toronto, Toronto, ON, Canada

    E. R. Bogoch

  6. Osteoporosis Canada, Toronto, ON, Canada

    R. Jain & J. Weldon

Authors
  1. D. E. Beaton
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  2. M. Vidmar
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  3. K. B. Pitzul
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  4. R. Sujic
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  6. E. R. Bogoch
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  7. J. E. M. Sale
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Corresponding author

Correspondence to D. E. Beaton.

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Conflict of interests

Beaton DE, Vidmar M, Pitzul KB, Sujic R, Rotondi NK, Sale JME, Jain R, and Weldon J declare that they have no conflicts of interest. Bogoch E reports unrestricted research grants from Amgen Canada Inc. and Clifford Martin and speaker fees from Amgen Canada Inc.

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Beaton, D.E., Vidmar, M., Pitzul, K.B. et al. Addition of a fracture risk assessment to a coordinator’s role improved treatment rates within 6 months of screening in a fragility fracture screening program. Osteoporos Int 28, 863–869 (2017). https://doi.org/10.1007/s00198-016-3794-1

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  • DOI: https://doi.org/10.1007/s00198-016-3794-1

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