A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture

Maria Teresa Cuddihy, Peter C Amadio, Sherine E. Gabriel, V. Shane Pankratz, Robert L. Kurland, L. Joseph Melton

Research output: Contribution to journalArticle

61 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)695-700
Number of pages6
JournalOsteoporosis International
Volume15
Issue number9
DOIs
StatePublished - Sep 2004

Fingerprint

Forearm
Osteoporosis
Densitometry
Primary Care Physicians
Referral and Consultation
Bone and Bones
Therapeutics
Physicians
Secondary Prevention
Practice Guidelines
Bone Density
Population
Patient Care
Guidelines
Costs and Cost Analysis
Wounds and Injuries

Keywords

  • Adherence
  • Osteoporosis treatment
  • Postfracture interventions

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture. / Cuddihy, Maria Teresa; Amadio, Peter C; Gabriel, Sherine E.; Pankratz, V. Shane; Kurland, Robert L.; Melton, L. Joseph.

In: Osteoporosis International, Vol. 15, No. 9, 09.2004, p. 695-700.

Research output: Contribution to journalArticle

Cuddihy, Maria Teresa ; Amadio, Peter C ; Gabriel, Sherine E. ; Pankratz, V. Shane ; Kurland, Robert L. ; Melton, L. Joseph. / A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture. In: Osteoporosis International. 2004 ; Vol. 15, No. 9. pp. 695-700.
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