Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Jan;23(1):87-95.
doi: 10.1007/s00198-011-1726-7. Epub 2011 Jul 16.

Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial

S B Jaglal  1 , O S Donescu, V Bansod, J Laprade, K Thorpe, G Hawker, S R Majumdar, L Meadows, S M Cadarette, A Papaioannou, M Kloseck, D Beaton, E Bogoch, M Zwarenstein
Affiliations
Randomized Controlled Trial

Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial

S B Jaglal et al. Osteoporos Int. 2012 Jan.

Abstract

We conducted a cluster randomized trial evaluating the effect of a centralized coordinator who identifies and follows up with fracture patients and their primary care physicians about osteoporosis. Compared with controls, intervention patients were five times more likely to receive BMD testing and two times more likely to receive appropriate management.

Introduction: To determine if a centralized coordinator who follows up with fracture patients and their primary care physicians by telephone and mail (intervention) will increase the proportion of patients who receive appropriate post-fracture osteoporosis management, compared to simple fall prevention advice (attention control).

Methods: A cluster randomized controlled trial was conducted in small community hospitals in the province of Ontario, Canada. Hospitals that treated between 60 and 340 fracture patients per year were eligible. Patients 40 years and older presenting with a low trauma fracture were identified from Emergency Department records and enrolled in the trial. The primary outcome was 'appropriate' management, defined as a normal bone mineral density (BMD) test or taking osteoporosis medications.

Results: Thirty-six hospitals were randomized to either intervention or control and 130 intervention and 137 control subjects completed the study. The mean age of participants was 65 ± 12 years and 69% were female. The intervention increased the proportion of patients who received appropriate management within 6 months of fracture; 45% in the intervention group compared with 26% in the control group (absolute difference of 19%; adjusted OR, 2.3; 95% CI, 1.3-4.1). The proportion who had a BMD test scheduled or performed was much higher with 57% of intervention patients compared with 21% of controls (absolute difference of 36%; adjusted OR, 4.8; 95% CI, 3.0-7.0).

Conclusions: A centralized osteoporosis coordinator is effective in improving the quality of osteoporosis care in smaller communities that do not have on-site coordinators or direct access to osteoporosis specialists.

Trial registration: ClinicalTrials.gov NCT00511693.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow of patients through the trial
See this image and copyright information in PMC

References

    1. Brown JP, Josse RG, Scientific Advisory Council of the Osteoporosis Society of Canada Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002;167(10 Suppl):S1–S34. - PMC - PubMed
    1. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown J, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD (2010) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2010. doi:10.1503/cmaj.100771 - PMC - PubMed
    1. Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA. 2007;297(4):387–394. doi: 10.1001/jama.297.4.387. - DOI - PubMed
    1. Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int. 2004;15(10):767–778. doi: 10.1007/s00198-004-1675-5. - DOI - PubMed
    1. Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD. Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum. 2006;35(5):293–305. doi: 10.1016/j.semarthrit.2005.11.001. - DOI - PubMed

Publication types

MeSH terms

Substances

Associated data

Grants and funding