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A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures

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Abstract

Introduction

Despite the high risk for subsequent fracture following an initial osteoporotic fracture, the majority of subjects with minimal trauma fractures receive no treatment for osteoporosis. The primary aim of this investigation was to determine whether an information-based intervention could change post-fracture management of osteoporosis. A secondary aim was to define participant- and doctor-related barriers to osteoporosis management.

Methods

Consecutive fracture patients (n=254) from the outpatient fracture clinic at St Vincent’s Hospital, Sydney were interviewed over a 15-month period (February 2002–July 2003). Fracture risk factors, prior investigation and treatment for osteoporosis were collected at baseline. Participants were initially contacted after 3 months to ascertain follow-up management. All those not investigated or treated by their primary care physician were then randomized to either a personalized letter or the same letter plus an offer of a free bone mineral density (BMD) test. Participants were contacted after 9 months to record further investigations or treatment for osteoporosis.

Results

Less than 20% of the participants had a primary care physician follow-up 3 months after the fracture, leaving 159 who were randomized to a personalized letter (n=79) and a personalized letter plus the offer of a free BMD test (n=80). There was a significant increase in the number of people investigated for osteoporosis in the group receiving the letter plus BMD offer [38% (letter + BMD) vs. 7% (letter only); p=0.001). A high proportion of those tested had low BMD (49% osteopenia and 17% osteoporosis). However, the rates of treatment in both groups were very low (6%). Furthermore, even among the few individuals (23%) who contacted their primary care physician, only 25% were recommended treatment. The belief that the fracture was osteoporotic was an independent predictor of having a BMD test, a primary care physician follow-up and treatment. Other independent predictors were age over 50 years for a primary care physician follow-up, female sex for having a BMD test and having had a BMD test for treatment.

Conclusion

This study demonstrates that an information-based intervention led to a modest increase in the proportion of people investigated for osteoporosis; however. there was no significant effect on treatment rates. The offer of a free BMD assessment was associated with a significantly higher rate of investigation than a personalized letter alone (odds ratio: 8.5; 95% confidence interval: 3.1–24.5), but this investigation did not affect treatment rate. The low uptake of either a BMD or a visit to a primary care physician together with low rates of treatment recommendation even among people who contacted their primary care physician reflects significant participant and doctor-related barriers to osteoporosis management.

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References

  1. Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902

    Article  PubMed  CAS  Google Scholar 

  2. Sanders KM, Nicholson GC, Ugoni AM, Pasco JA, Seeman E, Kotowicz MA (1999) Health burden of hip and other fractures in Australia beyond 2000. Projections based on the Geelong Osteoporosis Study. Med J Aust 170:467–470

    PubMed  CAS  Google Scholar 

  3. ACT A E P L C (2001) The burden of brittle bones: costing osteoporosis in Australia. ACT AEPLC, Australia

  4. Melton LJ 3rd (2003) Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res 18:1139–1141

    Article  PubMed  Google Scholar 

  5. Randell A, Sambrook PN, Nguyen TV, Lapsley H, Jones G, Kelly PJ et al (1995) Direct clinical and welfare costs of osteoporotic fractures in elderly men and women. Osteoporos Int 5:427–432

    Article  PubMed  CAS  Google Scholar 

  6. Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW et al (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373

    PubMed  Google Scholar 

  7. Brown JP, Josse RG (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J 167:S1–S34

    Google Scholar 

  8. Jones G, Nguyen T, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA (1994) Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos Int 4:277–282

    Article  PubMed  CAS  Google Scholar 

  9. Sanders KM, Seeman E, Ugoni AM, Pasco JA, Martin TJ, Skoric B et al (1999) Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos Int 10:240–247

    Article  PubMed  CAS  Google Scholar 

  10. Briancon D, de Gaudemar JB, Forestier R (2004) Management of osteoporosis in women with peripheral osteoporotic fractures after 50 years of age: a study of practices. J Bone Spine 71:128–130

    Article  Google Scholar 

  11. Simonelli C, Chen YT, Morancey J, Lewis AF, Abbott TA (2003) Evaluation and management of osteoporosis following hospitalization for low-impact fracture. J Gen Intern Med 18:17–22

    Article  PubMed  Google Scholar 

  12. Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. Can Med Assoc J 163:819–822

    CAS  Google Scholar 

  13. Sanders KM, Pasco JA, Ugoni AM, Nicholson GC, Seeman E, Martin TJ et al (1998) The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: the Geelong Osteoporosis Study. J Bone Miner Res 13:1337–1342

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  15. Doherty DA, Sanders KM, Kotowicz MA, Prince RL (2001) Lifetime and five-year age-specific risks of first and subsequent osteoporotic fractures in postmenopausal women. Osteoporos Int 12:16–23

    Article  PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  CAS  Google Scholar 

  17. Mallmin H, Ljunghall S, Persson I, Naessen T, Krusemo UB, Bergstrom R (1993) Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int 52:269–272

    Article  PubMed  CAS  Google Scholar 

  18. Robinson CM, Royds M, Abraham A, McQueen MM, Court-Brown CM, Christie J (2002) Refractures in patients at least forty-five years old. a prospective analysis of twenty-two thousand and sixty patients. J Bone Jt Surg Am 84-A:1528–1533

    CAS  Google Scholar 

  19. van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629

    Article  PubMed  Google Scholar 

  20. Diamond T, Sambrook P, Williamson M, Flicker L, Nowson C, Fiatarone-Singh M et al (2001) Guidelines for treatment of osteoporosis in men. Aust Fam Physician 30:787–791

    PubMed  CAS  Google Scholar 

  21. Kanis JA, Black D, Cooper C, Dargent P, Dawson-Hughes B, De Laet C et al (2002) A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 13:527–536

    Article  PubMed  CAS  Google Scholar 

  22. Bellantonio S, Fortinsky R, Prestwood K (2001) How well are community-living women treated for osteoporosis after hip fracture? J Am Geriatr Soc 49:1197–1204

    Article  PubMed  CAS  Google Scholar 

  23. Follin SL, Black JN, McDermott MT (2003) Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Pharmacotherapy 23:190–198

    Article  PubMed  Google Scholar 

  24. Hooven F, Gehlbach SH, Pekow P, Bertone E, Benjamin E (2004) Follow-up treatment for osteoporosis after fracture. Osteoporos Int 16:296–301

    Article  PubMed  Google Scholar 

  25. Panneman MJ, Lips P, Sen SS, Herings RM (2004) Undertreatment with anti-osteoporotic drugs after hospitalization for fracture. Osteoporos Int 15:120–124

    Article  PubMed  Google Scholar 

  26. Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5:11

    Article  PubMed  CAS  Google Scholar 

  27. Port L, Center J, Briffa NK, Nguyen T, Cumming R, Eisman J (2003) Osteoporotic fracture: missed opportunity for intervention. Osteoporos Int 14:780–784

    Article  PubMed  Google Scholar 

  28. Sahota O, Worley A, Hosking DJ (2000) An audit of current clinical practice in the management of osteoporosis in Nottingham. J Public Health Med 22:466–472

    Article  PubMed  CAS  Google Scholar 

  29. Smith MD, Ross W, Ahern MJ (2001) Missing a therapeutic window of opportunity: an audit of patients attending a tertiary teaching hospital with potentially osteoporotic hip and wrist fractures. J Rheumatol 28:2504–2508

    PubMed  CAS  Google Scholar 

  30. Wong PK, Spencer DG, McElduff P, Manolios N, Larcos G, Howe GB (2003) Secondary screening for osteoporosis in patients admitted with minimal-trauma fracture to a major teaching hospital. Intern Med J 33:505–510

    Article  PubMed  CAS  Google Scholar 

  31. Gardner MJ, Flik KR, Mooar P, Lane JM (2002) Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Jt Surg Am 84-A:1342–1348

    Google Scholar 

  32. Feldstein AC, Nichols GA, Elmer PJ, Smith DH, Aickin M, Herson M (2003) Older women with fractures: patients falling through the cracks of guideline-recommended osteoporosis screening and treatment. J Bone Jt Surg Am 85-A:2294–2302

    Google Scholar 

  33. 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

    Article  PubMed  Google Scholar 

  34. Taylor JC, Sterkel B, Utley M, Shipley M, Newman S, Horton M et al (2001) Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management. Osteoporos Int 12:844–848

    Article  PubMed  CAS  Google Scholar 

  35. Cuddihy MT (2003) Barriers to postfracture osteoporosis care in postmenopausal women. J Gen Intern Med 18:70–71

    Article  PubMed  Google Scholar 

  36. Mauck KF, Cuddihy MT, Trousdale RT, Pond GR, Pankratz VS, Melton LJ 3rd (2002) The decision to accept treatment for osteoporosis following hip fracture: exploring the woman’s perspective using a stage-of-change model. Osteoporos Int 13:560–564

    Article  PubMed  CAS  Google Scholar 

  37. Altman DG (1999) Practical statistics for medical research, 2nd edn. Chapman & Hall, London

  38. 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

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the Orthopaedic Department and the staff from St. Vincent’s Hospital Fracture Clinic for their support with the data collection. We would also like to thank Ms. Natasa Ivankovic for her help with participants’ randomization and to acknowledge the help of the staff from Nuclear Medicine Department at St. Vincent’s Clinic for DXA scanning. We are grateful to the participants for their essential contribution to this study.

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Bliuc, D., Eisman, J.A. & Center, J.R. A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures. Osteoporos Int 17, 1309–1317 (2006). https://doi.org/10.1007/s00198-006-0078-1

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  • DOI: https://doi.org/10.1007/s00198-006-0078-1

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