A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture

• Published in: Osteoporosis international 2004-09, Vol.15 (9), p.695-700
• Main Authors: CUDDIHY, Maria-Teresa, AMADIO, Peter C, GABRIEL, Sherine E, PANKRATZ, V. Shane, KURLAND, Robert L, MELTON, L. Joseph
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Aged; Aged, 80 and over; Biological and medical sciences; Bone density; Clinical medicine; Dementia; Diseases of the osteoarticular system; Educational materials; Female; Forearm Injuries - etiology; Fractures; Fractures, Bone - etiology; Humans; Internal medicine; Intervention; Male; Medical referrals; Medical sciences; Medicine; Middle Aged; Orthopedics; Osteoporosis; Osteoporosis - complications; Osteoporosis - drug therapy; Osteoporosis - therapy; Osteoporosis. Osteomalacia. Paget disease; Patient Acceptance of Health Care - psychology; Patient Compliance; Patient Education as Topic; Patients; Physicians; Prevention; Primary care; Prospective Studies; Trauma; Treatment Outcome
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-004-1597-2

Secondary prevention of osteoporosis after fracture is underutilized, despite cost-effective therapies. This clinical practice intervention aimed to improve osteoporosis care of the postfracture patient. Residents of Olmsted County, Minnesota, USA, > or = age 45 who sustained a moderate trauma distal forearm fracture were identified, and participants received educational materials, referral for bone densitometry and physician consultation to address osteoporosis in January 1999 through October 2000. Osteoporosis educational materials were provided to patients at the time of recruitment, and primary care physicians provided osteoporosis practice guidelines. Outcomes included: completion of bone densitometry, acceptance of interventions at the first postfracture primary care physician visit, and adherence to advice at 6 months. There were 105 patients identified (80% women), but only 58 agreed to participate (88% women). Women with lower T-scores (< -1.5) had an 89% initial treatment rate, and 67% were adherent to treatment at 6 months. All women with normal bone density (T-score above -1.5) were advised by their primary care physicians about antiresorptive treatment, and 100% adhered to these recommendations, even though they were not eligible for such treatment based on the National Osteoporosis Foundation (NOF) guidelines. None of the men accepted the treatments offered, despite T-scores that fell at or below the NOF treatment threshold. Bone densitometry and consultation improved osteoporosis interventions after index fracture from a 16% baseline rate in the population (1993-1997) to a 45% overall rate for the study population. In summary, while referral for bone densitometry and discussion by a physician about postfracture osteoporosis preventive treatments did increase treatment rate, the majority of patients at highest risk did not accept interventions. Further initiatives are needed to overcome both system and patient barriers.