Osteoporosis International

, 19:1733

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

  • A. Cranney
  • M. Lam
  • L. Ruhland
  • R. Brison
  • M. Godwin
  • M. M. Harrison
  • M. B. Harrison
  • T. Anastassiades
  • J. M. Grimshaw
  • I. D. Graham
Original Artic le



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.


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.


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.


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.


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


Cluster randomized trial Multifaceted intervention Osteoporosis Wrist fractures 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • A. Cranney
    • 1
    • 10
  • M. Lam
    • 3
  • L. Ruhland
    • 5
  • R. Brison
    • 3
    • 4
  • M. Godwin
    • 9
  • M. M. Harrison
    • 6
  • M. B. Harrison
    • 7
  • T. Anastassiades
    • 5
    • 8
  • J. M. Grimshaw
    • 1
  • I. D. Graham
    • 1
    • 2
  1. 1.Clinical Epidemiology Program, Ottawa Health Research Institute, and Department of MedicineUniversity of OttawaOttawaCanada
  2. 2.Faculty of Health SciencesUniversity of OttawaOttawaCanada
  3. 3.Departments of Medicine, Community Health and EpidemiologyQueen’s UniversityKingstonCanada
  4. 4.Departments of Emergency Medicine and Family MedicineQueen’s UniversityKingstonCanada
  5. 5.Department of MedicineQueen’s UniversityKingstonCanada
  6. 6.Human Mobility Research Centre and Department of Orthopedic SurgeryQueen’s UniversityKingstonCanada
  7. 7.School of NursingQueen’s UniversityKingstonCanada
  8. 8.Human Mobility Research Centre and Division of RheumatologyQueen’s UniversityKingstonCanada
  9. 9.Primary Healthcare Research UnitMemorial UniversitySt John’sCanada
  10. 10.Clinical Epidemiology ProgramOttawa Health Research InstituteOttawaCanada

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