UNLABELLED: In a cluster randomized trial, we evaluated the effect of a multifaceted intervention (directed at both patient and primary care physician) on the rates of testing and treatment of osteoporosis in postmenopausal women within six months of their wrist fracture. Compared to usual care, women in the intervention practices were three times more likely to receive bone mineral density testing and prescribed osteoporosis treatments. INTRODUCTION:Postmenopausal women with wrist fractures are at increased risk of future fragility fractures, yet they frequently do not receive evaluation and treatment for osteoporosis. We set out to evaluate a multifaceted intervention designed to improve management of osteoporosis in older women with recent wrist fractures. METHODS: Cluster randomized trial of 270 women cared for in 119 primary care practices. We recruited postmenopausal women with an acute wrist fracture from the emergency departments of hospitals in southeastern Ontario, Canada. Family practices were randomly assigned to either the intervention or usual care. The intervention consisted of a mailed reminder with a summary of treatment guidelines and letter sent to the primary care physician, in addition to an educational package and letter to the women. The primary outcome was the proportion of women prescribed osteoporosis therapy within 6 months of their fracture. RESULTS:The mean age of women was 69(10.9) years. The intervention increased the proportion of women started on osteoporosis medications (28% vs. 10%) of controls, adjusted OR 3.45, 95% CI, 1.58-7.56, p = 0.002) and the proportion who had a bone mineral density (BMD) test (53.3% vs. 26%) of controls, OR 3.38, 95% CI, 1.83-6.26, p < 0.001). In addition to the intervention, having a female physician was a predictor of increased testing and treatment rates. CONCLUSION: A multifaceted intervention significantly improved rates of osteoporosis treatment and BMD testing in postmenopausal women with wrist fractures.
RCT Entities:
UNLABELLED: In a cluster randomized trial, we evaluated the effect of a multifaceted intervention (directed at both patient and primary care physician) on the rates of testing and treatment of osteoporosis in postmenopausal women within six months of their wrist fracture. Compared to usual care, women in the intervention practices were three times more likely to receive bone mineral density testing and prescribed osteoporosis treatments. INTRODUCTION: Postmenopausal women with wrist fractures are at increased risk of future fragility fractures, yet they frequently do not receive evaluation and treatment for osteoporosis. We set out to evaluate a multifaceted intervention designed to improve management of osteoporosis in older women with recent wrist fractures. METHODS: Cluster randomized trial of 270 women cared for in 119 primary care practices. We recruited postmenopausal women with an acute wrist fracture from the emergency departments of hospitals in southeastern Ontario, Canada. Family practices were randomly assigned to either the intervention or usual care. The intervention consisted of a mailed reminder with a summary of treatment guidelines and letter sent to the primary care physician, in addition to an educational package and letter to the women. The primary outcome was the proportion of women prescribed osteoporosis therapy within 6 months of their fracture. RESULTS: The mean age of women was 69(10.9) years. The intervention increased the proportion of women started on osteoporosis medications (28% vs. 10%) of controls, adjusted OR 3.45, 95% CI, 1.58-7.56, p = 0.002) and the proportion who had a bone mineral density (BMD) test (53.3% vs. 26%) of controls, OR 3.38, 95% CI, 1.83-6.26, p < 0.001). In addition to the intervention, having a female physician was a predictor of increased testing and treatment rates. CONCLUSION: A multifaceted intervention significantly improved rates of osteoporosis treatment and BMD testing in postmenopausal women with wrist fractures.
Authors: D M Black; M Steinbuch; L Palermo; P Dargent-Molina; R Lindsay; M S Hoseyni; O Johnell Journal: Osteoporos Int Date: 2001 Impact factor: 4.507
Authors: Maria-Teresa Cuddihy; Sherine E Gabriel; Cynthia S Crowson; Elizabeth J Atkinson; Claudia Tabini; W Michael O'Fallon; L Joseph Melton Journal: Arch Intern Med Date: 2002-02-25
Authors: Sumit R Majumdar; Jeffrey A Johnson; Finlay A McAlister; Debbie Bellerose; Anthony S Russell; David A Hanley; Don W Morrish; Walter P Maksymowych; Brian H Rowe Journal: CMAJ Date: 2008-02-26 Impact factor: 8.262
Authors: Ethel S Siris; Ya-Ting Chen; Thomas A Abbott; Elizabeth Barrett-Connor; Paul D Miller; Lois E Wehren; Marc L Berger Journal: Arch Intern Med Date: 2004-05-24
Authors: Adrianne Feldstein; Patricia J Elmer; David H Smith; Michael Herson; Eric Orwoll; Chuhe Chen; Mikel Aickin; Martha C Swain Journal: J Am Geriatr Soc Date: 2006-03 Impact factor: 5.562
Authors: Daniel H Solomon; Jennifer M Polinski; Margaret Stedman; Colleen Truppo; Laura Breiner; Catherine Egan; Saira Jan; Minal Patel; Thomas W Weiss; Ya-ting Chen; M Alan Brookhart Journal: J Gen Intern Med Date: 2007-03 Impact factor: 5.128
Authors: L Giangregorio; L Thabane; A Cranney; A Adili; J deBeer; L Dolovich; J D Adachi; A Papaioannou Journal: Orthop Nurs Date: 2010 Mar-Apr Impact factor: 0.913
Authors: S R Majumdar; J A Johnson; D Bellerose; F A McAlister; A S Russell; D A Hanley; S Garg; D A Lier; W P Maksymowych; D W Morrish; B H Rowe Journal: Osteoporos Int Date: 2010-04-01 Impact factor: 4.507
Authors: K Ganda; M Puech; J S Chen; R Speerin; J Bleasel; J R Center; J A Eisman; L March; M J Seibel Journal: Osteoporos Int Date: 2012-07-25 Impact factor: 4.507
Authors: M-C Laliberté; S Perreault; A Dragomir; J Goudreau; I Rodrigues; L Blais; N Damestoy; D Corbeil; L Lalonde Journal: Osteoporos Int Date: 2009-11-25 Impact factor: 4.507
Authors: Maria I Danila; Ryan C Outman; Elizabeth J Rahn; Amy S Mudano; David T Redden; Peng Li; Jeroan J Allison; Fred A Anderson; Allison Wyman; Susan L Greenspan; Andrea Z LaCroix; Jeri W Nieves; Stuart L Silverman; Ethel S Siris; Nelson B Watts; Michael J Miller; Jeffrey R Curtis; Amy H Warriner; Nicole C Wright; Kenneth G Saag Journal: J Bone Miner Res Date: 2018-02-26 Impact factor: 6.741
Authors: P Cram; F D Wolinsky; Y Lou; S W Edmonds; S F Hall; D W Roblin; N C Wright; M P Jones; K G Saag Journal: Osteoporos Int Date: 2016-06-30 Impact factor: 4.507