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Successful direct intervention for osteoporosis in patients with minimal trauma fractures

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Abstract

Summary

In this study, we offered osteoporosis investigation and treatment directly to patients at out-patient fracture clinics shortly after they sustained minimal trauma fractures. We achieved long-term compliance to the recommended investigation and treatment in 80% of patients. This approach is much more successful than previous interventions.

Introduction

Osteoporosis remains under-treated in minimal-trauma fracture subjects. The aim of this study was to determine if direct intervention at orthopaedic fracture clinics would improve post-fracture management in these subjects.

Methods

From March 2004 to March 2006, 155 consecutive minimal-trauma fracture subjects (mean age 64.0 ± 17.6) attending fracture clinics at St. Vincent’s Hospital, Sydney, had a specific medical assessment, following which they were recommended BMD and laboratory testing. Treatment recommendations were given after review of investigations with further follow-up at a median of 8.6 months following therapy. Comparison of outcomes was made with a similar group of patients given written information 2 years prior.

Results

At baseline, 47% of patients had prior fractures, but only 26% had had BMD screening. Twenty-one percent were on anti-resorptive therapy, and 15% were on calcium/vitamin D. Following intervention, 83% had a BMD and of these, 68% had a T-score < −1.0. Of treatment naïve patients, 44% were recommended anti-resorptive therapy and 56% were recommended calcium/vitamin D. Compliance was 80% for anti-resorptive and 76% for calcium/vitamin D. Female gender and lower BMD were predictors of compliance.

Conclusion

Compared with information-based intervention, direct intervention improved management two to fivefold, maintaining long-term treatment in 90% of osteoporotic and 73% of osteopenic subjects requiring therapy.

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Acknowledgement

The authors would like to thank the medical, nursing and clerical staff at St. Vincent’s Hospital Fracture Clinics for their assistance with data collection and logistic support. We are grateful for the services provided by the St. Vincent’s Clinic Nuclear Medicine and St. Vincent’s Hospital Pathology Department. We are also grateful for the untied financial support, at different times, by educational grants from Merck Sharp and Dohme Australia, Sanofi-Aventis and the St. Vincent’s Hospital Department of Nuclear Medicine. Lastly, our thanks go out to all the participants of the study, without whom, none of these would be possible.

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Authors and Affiliations

  1. Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, NSW, Australia

    I. Kuo, C. Ong, L. Simmons, D. Bliuc, J. Eisman & J. Center

  2. St. Vincent’s Hospital, Sydney, NSW, Australia

    I. Kuo, J. Eisman & J. Center

  3. University of New South Wales, Sydney, NSW, Australia

    D. Bliuc & J. Eisman

  4. Bone and Mineral Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia

    I. Kuo

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  1. I. Kuo
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  2. C. Ong
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  3. L. Simmons
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  4. D. Bliuc
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  5. J. Eisman
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  6. J. Center
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Correspondence to I. Kuo.

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Kuo, I., Ong, C., Simmons, L. et al. Successful direct intervention for osteoporosis in patients with minimal trauma fractures. Osteoporos Int 18, 1633–1639 (2007). https://doi.org/10.1007/s00198-007-0418-9

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  • DOI: https://doi.org/10.1007/s00198-007-0418-9

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