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. 2019 Oct;30(10):2119-2127.
doi: 10.1007/s00198-019-05074-8. Epub 2019 Jul 2.

A population-based study of postfracture care in Manitoba, Canada 2000/2001-2014/2015

Y Cui  1   2 , L M Lix  1   2 , S Yang  3 , S N Morin  4 , W D Leslie  5
Affiliations

A population-based study of postfracture care in Manitoba, Canada 2000/2001-2014/2015

Y Cui et al. Osteoporos Int. 2019 Oct.

Abstract

We previously found that population-based postfracture notification, which informed primary care physicians of their patient's recent fracture and suggested assessment for osteoporosis, led to an improvement in postfracture care in the context of a randomized controlled trial ( ClinicalTrials.gov identifier NCT00594789, fractures from late 2007 to mid-2010). Since June 2010, a province-wide postfracture notification program was implemented. This study was to (1) determine whether this program has resulted in sustained improvement in postfracture care and (2) test factors associated with receiving osteoporosis care.

Methods: A retrospective matched cohort study was performed using population-based health administrative data in Manitoba, Canada. We selected individuals aged 50+ years with an incident major osteoporosis fracture (MOF; N = 18,541) in fiscal years 2000/2001 to 2013/2014 and controls without a MOF (N = 92,705) matched (5:1) on age, sex, and residential area. The Cochran-Armitage test tested for a linear trend in osteoporosis care outcomes for cases and controls. Logistic regressions were used to test characteristics associated with the likelihood of receiving osteoporosis care.

Results: The percentage of individuals receiving DXA testing and/or osteoporosis medication increased in fracture cases (p < 0.001), but decreased in controls (p < 0.001). Odds ratios for osteoporosis care in years following the postfracture notification program were approximately double of those prior to the clinical trial. In addition to prior MOF (OR 9.03, 95% CI 8.60-9.48), factors associated with osteoporosis care included lower income (OR 0.72, 95% CI 0.67-0.78), glucocorticoid use (OR 4.37, 95% CI 3.72-5.14), diabetes diagnosis (OR = 0.74, 95% CI 0.68-0.80), and Charlson Comorbidity Index (indexes 1-2: OR 1.27, 95% CI 1.20-1.34; indexes 3-5: OR 1.26, 95% CI 1.13-1.40).

Conclusions: Adopting a population-based postfracture notification program led to sustained improvements in postfracture care.

Keywords: Bone mineral density; Fracture; Interventions; Osteoporosis; Postfracture care.

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