Abstract
BackgroundOsteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis are underutilized. This pragmatic randomised study was done to evaluate the impact of a multifaceted community-based care program aimed at optimizing evidence-based management in patients at risk for osteoporosis and fractures.MethodsThis was a 12-month randomized trial performed in Ontario, Canada. Eligible patients were community-dwelling, aged ≥55 years, and identified to be at risk for osteoporosis-related fractures. Two hundred and one patients were allocated to the intervention group or to usual care. Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing, patient education and patient-specific recommendations for osteoporosis treatment. The primary outcome was the implementation of appropriate osteoporosis management.Results101 patients were allocated to intervention and 100 to control. Mean age of participants was 71.9 ± 7.2 years and 94% were women. Pharmacological treatment (alendronate, risedronate, or raloxifene) for osteoporosis was increased by 29% compared to usual care (56% [29/52] vs. 27% [16/60]; relative risk [RR] 2.09, 95% confidence interval [CI] 1.29 to 3.40). More individuals in the intervention group were taking calcium (54% [54/101] vs. 20% [20/100]; RR 2.67, 95% CI 1.74 to 4.12) and vitamin D (33% [33/101] vs. 20% [20/100]; RR 1.63, 95% CI 1.01 to 2.65).ConclusionsA multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care.Trial RegistrationThis trial has been registered with clinicaltrials.gov (ID: NCT00465387)
Highlights
Osteoporosis-related fractures are a significant public health concern
It was conducted by the Group Health Centre (GHC), a notfor-profit health service community centre, in partnership with Sault Area Hospital (SAH), a facility with 250 active beds
Patient characteristics 590 patients were screened for eligibility, 389 were excluded and 201 patients were recruited from March 2003 to January 2006, with 101 patients randomized into the intervention protocol (IP) group, and 100 patients into the usual care group (Figure 1)
Summary
Osteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis are underutilized. Osteoporosis, a chronic condition characterized by low bone mass, microarchitectural deterioration of bone and increased risk of fracture, is a significant public health concern. It affects over 200 million people worldwide [1], an estimated 10 million people in the US [2], 4 million people in the UK [3] and 1.4 million people in Canada [2,4]. A substantial body of evidence supports the use of various interventions for the detection and treatment of osteoporosis in high risk patients, and the prevention of related fractures including therapy with calcium, vitamin D, and drugs that decrease bone resorption or increase bone formation [16]. Rates of osteoporosis treatment among elderly patients with a fracture of the wrist, hip or vertebrae are less than 10 to 20% in the year following fracture [18]
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