Abstract
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, ≥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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Riggs BL, Melton LJ III (1990) Clinical heterogeneity of involutional osteoporosis: Implications for preventive therapy. J Clin Endocrinol Metab 70:1229–1232
Eastell R (1999) Commentary: bone density can be used to assess fracture risk. BMJ 318(7187):864–865
Klotzbuecher CM, Ross PD, Landsman PB et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739
Freedman KB, Kaplan FS, Bilker WB et al (2000) Treatment of osteoporosis: Are physicians missing an opportunity? J Bone Joint Surg Am 82A(8):1063–1070
Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. Can Med Assoc J 163(7):819–822
Cauley JA, Seeley DG, Ensrud K et al (1995) Estrogen replacement therapy and fractures in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 122:9–16
Cuddihy MT, Gabriel SE, Crowson CS et al (2002) Osteoporosis interventions following distal forearm fractures: a missed opportunity. Arch Intern Med 162:421–426
Rubin SM, Cummings SR (1992) The results of bone densitometry affect women’s decisions about taking measures to prevent fractures. Ann Intern Med 116:990–995
Solomon D, Leven E, Helfgott SM (2000) Pattern of medication use before and after bone densitometry: factors associated with appropriate treatment. J Rheumatol 27:1496–1500
Melton LJ III (1996) History of the Rochester Epidemiology Project. Mayo Clin Proc 71:266–274
Folstein M, Folstein S, McHugh P (1975) Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198
Lydick E, Zimmerman S, Yawn B et al (1997) Development and validation of a discriminative quality of life questionnaire for osteoporosis (the OPToQOL). J Bone Miner Res 12(3):456–463
Cuddihy MT, Amadio PC, Melton LJ III (2002) Patient barriers to osteoporosis interventions after fracture [letter to the editor]. Mayo Clin Proc 77:875–876
Eddy D, Johnston CC, Cummings SR et al (1998) Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Osteoporos Int 8[Suppl 4]:1–88
Looker AC, Orwoll ES, Johnston CC et al (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12(11):1761–1768
Kanis JA, Gluer CC (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int 11:192–202
Orwoll ES (1998) Osteoporosis in men. Endocrinol Metab Clin North Am 27(2):349–367
Cuddihy MT, Gabriel SE, Sloan JA, Crowson CS, Melton LJ III (2002) Osteoporosis health beliefs among postmenopausal women with a history of distal forearm fracture. Clin J Women’s Health 2(2):79–87
Melton LJ III (2000) Who has osteoporosis? A conflict between clinical and public health perspectives. J Bone Miner Res 15:2309–2314
Acknowledgements
The authors wish to recognize Claudia Tabini and Tina Wagenbach who helped to manage patients from recruitment to follow-up. We appreciate the willing participation and support of the staff and physicians in the Mayo Clinic Department of Orthopedics and Division of Community Medicine; and Olmsted Medical Center primary care physicians.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cuddihy, MT., Amadio, P.C., Gabriel, S.E. et al. A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture. Osteoporos Int 15, 695–700 (2004). https://doi.org/10.1007/s00198-004-1597-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-004-1597-2