Osteoporosis International

, Volume 15, Issue 9, pp 695–700

A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture

  • Maria-Teresa Cuddihy
  • Peter C. Amadio
  • Sherine E. Gabriel
  • V. Shane Pankratz
  • Robert L. Kurland
  • L. Joseph MeltonIII
Original Article

Abstract

Secondary prevention of osteoporosis after fracture is underutilized, despite cost-effective therapies. This clinical practice intervention aimed to improve osteoporosis care of the postfracture patient. Residents of Olmsted County, Minnesota, USA, ≥age 45 who sustained a moderate trauma distal forearm fracture were identified, and participants received educational materials, referral for bone densitometry and physician consultation to address osteoporosis in January 1999 through October 2000. Osteoporosis educational materials were provided to patients at the time of recruitment, and primary care physicians provided osteoporosis practice guidelines. Outcomes included: completion of bone densitometry, acceptance of interventions at the first postfracture primary care physician visit, and adherence to advice at 6 months. There were 105 patients identified (80% women), but only 58 agreed to participate (88% women). Women with lower T-scores (<−1.5) had an 89% initial treatment rate, and 67% were adherent to treatment at 6 months. All women with normal bone density (T-score above −1.5) were advised by their primary care physicians about antiresorptive treatment, and 100% adhered to these recommendations, even though they were not eligible for such treatment based on the National Osteoporosis Foundation (NOF) guidelines. None of the men accepted the treatments offered, despite T-scores that fell at or below the NOF treatment threshold. Bone densitometry and consultation improved osteoporosis interventions after index fracture from a 16% baseline rate in the population (1993–1997) to a 45% overall rate for the study population. In summary, while referral for bone densitometry and discussion by a physician about postfracture osteoporosis preventive treatments did increase treatment rate, the majority of patients at highest risk did not accept interventions. Further initiatives are needed to overcome both system and patient barriers.

Keywords

Adherence Osteoporosis treatment Postfracture interventions 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Maria-Teresa Cuddihy
    • 1
    • 5
  • Peter C. Amadio
    • 2
  • Sherine E. Gabriel
    • 3
  • V. Shane Pankratz
    • 3
  • Robert L. Kurland
    • 4
  • L. Joseph MeltonIII
    • 3
  1. 1.Division of General Internal Medicine (Area), Department of Internal MedicineMayo Clinic and Mayo FoundationRochesterUSA
  2. 2.Department of OrthopedicsMayo Clinic and Mayo FoundationRochesterUSA
  3. 3.Department of Health Sciences ResearchMayo Clinic and Mayo FoundationRochesterUSA
  4. 4.Department of OrthopedicsOlmsted Medical CenterRochesterUSA
  5. 5.Division of General Medicine and Primary Care, Department of Internal MedicineBeth Israel Deaconess Medical CenterBostonUSA

Personalised recommendations