A Postfracture Initiative to Improve Osteoporosis Management in a Community Hospital in Ontario

• Published in: Journal of bone and joint surgery. American volume Vol. 92; no. 10; pp. 1973 - 1980
• Main Authors: Sale, Joanna E.M., Beaton, Dorcas E., Elliot-Gibson, Victoria I.M., Bogoch, Earl R., Ingram, Jennifer
• Format: Journal Article
• Language: English
• Published: Boston, MA The Journal of Bone and Joint Surgery, Inc 18-08-2010; Journal of Bone and Joint Surgery Incorporated
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bone Density; Diseases of the osteoarticular system; Female; Fractures, Bone - complications; Fractures, Bone - prevention & control; Fractures, Bone - therapy; Health Knowledge, Attitudes, Practice; Hospitals, Community; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Ontario; Orthopedic surgery; Osteoporosis - complications; Osteoporosis - prevention & control; Osteoporosis - therapy; Osteoporosis. Osteomalacia. Paget disease; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveys and Questionnaires; Treatment Outcome; Canada; North America; Ontario; America; Osteoporosis; Orthopedic surgery; Treatment; Hospital; Diseases of the osteoarticular system
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.I.00878

Screening programs to manage osteoporosis in fracture clinic environments have had varying success in terms of increasing rates of investigation and initiation of treatment for the disease.
We determined rates of postfracture investigation and care for osteoporosis in patients screened through a coordinator-based initiative in a community hospital fracture clinic. A coordinator screened outpatients, educated them about osteoporosis, advised them to see their family physician for assessment and/or treatment, and performed follow-up at six months. Men who were fifty years of age or older and women who were forty years of age or older and had a fragility fracture were eligible.
Of 505 patients enrolled at baseline, 332 (66%) returned the follow-up questionnaire; 51% of those patients reported having had a bone mineral density test after screening and 26% had initiated first-line treatment (35% if the patients who had already initiated treatment at baseline were excluded) and an additional 23% were continuing treatment since baseline. After adjustment for demographic and baseline variables, patients who had initiated first-line treatment after screening were 4.15 times more likely to have had a bone mineral density test after screening than patients who had never initiated treatment and 11.67 times more likely to have had a bone mineral density test after screening than patients who had continued treatment since baseline.
A coordinator-based osteoporosis screening program was associated with osteoporosis investigation and treatment. A postfracture bone mineral density test was highly associated with treatment initiation.