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Key outcomes are usually not reported in published fracture secondary prevention programs: results of a systematic review

  • Osteoporotic Fracture Management
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

A secondary analysis of a systematic review on interventions to improve osteoporosis (OP) investigation and treatment was conducted to examine reported key outcomes: (1) the cost of the intervention; (2) the proportion of patients taking OP medication beyond 6 months of the intervention; and (3) the proportion of patients who re-fractured.

Methods

Fifty-seven articles reporting on 54 studies (64 interventions) from 11 countries were included. Intervention studies to improve OP management were eligible if they were conducted in an orthopedic setting and included primary data on ≥20 patients presenting with a hip fracture or any fragility fracture. To compare outcome data across all interventions regardless of study design, an equated proportion (EP) using a denominator based on the intention-to-treat principle was derived. Whether a cost analysis had been conducted, the EP of patients who were taking medication beyond 6 months of the intervention, and the EP of patients who re-fractured during the study period were documented.

Results

Of the 54 studies, 2 reported a cost analysis and demonstrated that the interventions were at least cost-effective. The EP for medication use beyond 6 months of the intervention ranged from 17 to 56% for four studies. The EP for re-fracture ranged from 0 to 5% for four studies.

Conclusion

Most interventions did not report key outcomes. In addition, authors used varying time frames for re-fracture and medication use, making direct comparisons impossible. Authors should consider including intervention costs, medication use beyond 6 months of the intervention, and re-fracture data in future fracture secondary prevention programs.

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Acknowledgments

This project was funded by the Ministry of Health and Long-Term Care (MOHLTC) of Ontario, through the Ontario Osteoporosis Strategy. Joanna Sale was funded, in part, by the MOHLTC. The views expressed are those of the authors and do not necessarily reflect those of the Ministry. The authors thank David Lightfoot for library support, Katherine Edwards, Iman Ahsan, and Rebeka Sujic for their help with article selection, and Ryan Thomas for technical support. We thank Osteoporosis Canada and the Ontario Osteoporosis Strategy for their interest in and support for this project.

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Authors and Affiliations

  1. Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Joanna E. M. Sale, Dorcas Beaton, Josh Posen & Victoria Elliot-Gibson

  2. Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada

    Joanna E. M. Sale & Dorcas Beaton

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

    Earl Bogoch

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

    Earl Bogoch

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  1. Joanna E. M. Sale
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Correspondence to Joanna E. M. Sale.

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Sale, J.E.M., Beaton, D., Posen, J. et al. Key outcomes are usually not reported in published fracture secondary prevention programs: results of a systematic review. Arch Orthop Trauma Surg 134, 283–289 (2014). https://doi.org/10.1007/s00402-011-1442-y

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