Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. Export

@article{citeulike:2946989, abstract = {BACKGROUND: Older patients who experience a fragility fracture are at high risk of future fractures but are rarely tested or treated for osteoporosis. We developed a multifaceted intervention directed at older patients with wrist fractures (in the form of telephone-based education) and their physicians (in the form of guidelines endorsed by opinion leaders, supported by reminders) to improve the quality of osteoporosis care. METHODS: In a randomized controlled trial with blinded ascertainment of outcomes, we compared our intervention with usual care (provision of printed educational materials to patients). Eligible patients were those older than 50 years of age who had experienced a wrist fracture and were seen in emergency departments and fracture clinics; we excluded those who were already being treated for osteoporosis. The primary outcome was bisphosphonate treatment within 6 months after the fracture. Secondary outcomes included bone mineral density testing, "appropriate care" (consisting of bone mineral density testing with treatment if bone mass was low) and quality of life. RESULTS: We screened 795 patients for eligibility and randomly assigned 272 to the intervention (137 patients) or control (135 patients) group. The median age was 60 years; 210 (77\%) of the subjects were women, and 130 (48\%) reported a previous fracture as an adult. Six months after the fracture, 30 (22\%) of the intervention patients, as compared with 10 (7\%) of the control patients, were receiving bisphosphonate therapy for osteoporosis (adjusted relative risk [RR] 2.6, 95\% confidence interval [CI] 1.3-5.1, p = 0.008). Intervention patients were more likely than control patients to undergo bone mineral density testing (71/137 [52\%] v. 24/135 [18\%]; adjusted RR 2.8, 95\% CI 1.9-4.2, p < 0.001) and to receive appropriate care (52/137 [38\%] v. 15/135 [11\%]; adjusted RR 3.1, 95\% CI 1.8-5.3, p < 0.001). There were no differences between the groups in other outcomes. One patient died, and 4 others experienced recurrent fracture. INTERPRETATION: A multifaceted intervention directed at high-risk patients and their physicians substantially increased rates of testing and treatment for osteoporosis. Nevertheless, more than half of the patients in the intervention group were not receiving appropriate care 6 months after their fracture, which suggests that additional strategies should be explored. (ClinicalTrials.gov trial register no. NCT00152321.).}, address = {Department of Medicine, University of Alberta, Edmonton, Alta. me2.majumdar@ualberta.ca}, author = {Majumdar, S. R. and Johnson, J. A. and McAlister, F. A. and Bellerose, D. and Russell, A. S. and Hanley, D. A. and Morrish, D. W. and Maksymowych, W. P. and Rowe, B. H.}, citeulike-article-id = {2946989}, citeulike-linkout-0 = {http://dx.doi.org/10.1503/cmaj.070981}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/18299546}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=18299546}, day = {26}, doi = {10.1503/cmaj.070981}, issn = {1488-2329}, journal = {CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne}, keywords = {fracture\_osteoporotique}, month = {February}, number = {5}, pages = {569--575}, posted-at = {2008-07-01 09:37:05}, priority = {2}, title = {Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial.}, url = {http://dx.doi.org/10.1503/cmaj.070981}, volume = {178}, year = {2008} }

TY - JOUR ID - citeulike:2946989 L3 - citeulike-article-id:2946989 N2 - BACKGROUND: Older patients who experience a fragility fracture are at high risk of future fractures but are rarely tested or treated for osteoporosis. We developed a multifaceted intervention directed at older patients with wrist fractures (in the form of telephone-based education) and their physicians (in the form of guidelines endorsed by opinion leaders, supported by reminders) to improve the quality of osteoporosis care. METHODS: In a randomized controlled trial with blinded ascertainment of outcomes, we compared our intervention with usual care (provision of printed educational materials to patients). Eligible patients were those older than 50 years of age who had experienced a wrist fracture and were seen in emergency departments and fracture clinics; we excluded those who were already being treated for osteoporosis. The primary outcome was bisphosphonate treatment within 6 months after the fracture. Secondary outcomes included bone mineral density testing, "appropriate care" (consisting of bone mineral density testing with treatment if bone mass was low) and quality of life. RESULTS: We screened 795 patients for eligibility and randomly assigned 272 to the intervention (137 patients) or control (135 patients) group. The median age was 60 years; 210 (77%) of the subjects were women, and 130 (48%) reported a previous fracture as an adult. Six months after the fracture, 30 (22%) of the intervention patients, as compared with 10 (7%) of the control patients, were receiving bisphosphonate therapy for osteoporosis (adjusted relative risk [RR] 2.6, 95% confidence interval [CI] 1.3-5.1, p = 0.008). Intervention patients were more likely than control patients to undergo bone mineral density testing (71/137 [52%] v. 24/135 [18%]; adjusted RR 2.8, 95% CI 1.9-4.2, p < 0.001) and to receive appropriate care (52/137 [38%] v. 15/135 [11%]; adjusted RR 3.1, 95% CI 1.8-5.3, p < 0.001). There were no differences between the groups in other outcomes. One patient died, and 4 others experienced recurrent fracture. INTERPRETATION: A multifaceted intervention directed at high-risk patients and their physicians substantially increased rates of testing and treatment for osteoporosis. Nevertheless, more than half of the patients in the intervention group were not receiving appropriate care 6 months after their fracture, which suggests that additional strategies should be explored. (ClinicalTrials.gov trial register no. NCT00152321.). IS - 5 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne SN - 1488-2329 AD - Department of Medicine, University of Alberta, Edmonton, Alta. me2.majumdar@ualberta.ca EP - 575 TI - Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. VL - 178 SP - 569 KW - fracture_osteoporotique AU - Majumdar, SR AU - Johnson, JA AU - McAlister, FA AU - Bellerose, D AU - Russell, AS AU - Hanley, DA AU - Morrish, DW AU - Maksymowych, WP AU - Rowe, BH PY - 2008/02/26/ UR - http://dx.doi.org/10.1503/cmaj.070981 ER -