Please select the eligibility criteria that correspond to the clinical trial below.
Title: Controlled Trial to Increase Detection and Treatment of Osteoporosis in Older Patients With a Wrist Fracture
Brief Summary: The primary objective of this proposed research is to improve the quality of care for patients who present to the Emergency Department with osteoporosis and a fracture of the wrist, by increasing the use of proven efficacious osteoporosis treatment. This is the primary study outcome, and it is defined as starting any one of hormone therapy, a bisphosphonate, raloxifene, or calcitonin within 6 months of a fracture of the wrist.

The study hypothesis is that a quality improvement intervention (with multiple components that include a notification system for primary care physicians, patient-specific reminders, locally generated treatment guidelines endorsed by opinion leaders, and patient education and counseling) will lead to increased use of proven efficacious osteoporosis treatments in patients eligible for secondary prevention. This hypothesis will be tested by comparing the intervention with usual care controls, in a prospective nonrandomized controlled trial.


Options:
A: Inclusion Criteria:

* Women and men age 50 and older with one of the following fracture definitions:

  * Hip fracture (physician ICD-9-CM 820-821 plus a procedure code for site-specific fracture reduction or fixation, open or closed)
  * Spine fracture (physician ICD-9-CM code 805), or
  * Humerus fracture (physician ICD-9-CM code 812), or
  * Colles' fracture (physician ICD-9-CM code 813 plus a physician claim for site-specific fracture reduction or fixation, open or closed, or cast application).

Exclusion Criteria:

* Age less than 50.
* Non-Manitoba residents, cancelled Manitoba Health coverage, death or discharge to a personal care home.
* A fracture event in the previous 12 months meeting the study case definition (i.e., only a single notification per year is planned).
* Hip or wrist fractures without a procedure tariff.
* Current treatment with an osteoporosis medication.
* BMD testing within the preceding 3 years.
B: Inclusion Criteria:

* 55 years of age or older
* independent living within the city of Sault Ste. Marie, Ontario, Canada
* capable of providing informed consent

Exclusion Criteria:

* not at risk for falls
* unable to give informed consent
C: Inclusion Criteria:

All patients 50 years of age or older with a wrist fracture who present to the Emergency Departments or Fracture Clinics at our two study sites will be eligible for study enrollment. Specifically:

1. Age 50 years or greater,
2. Any distal forearm fracture

Exclusion Criteria:

1. Unable to give simple informed consent,
2. Unwilling to participate in the study,
3. Unable to understand, read, or converse in English,
4. Place of residence outside Capital Health or longterm care facility,
5. Already receiving osteoporosis treatment with a bisphosphonate,
6. Previously documented allergy or intolerance to a bisphosphonate,
7. Currently enrolled in the pilot study or other osteoporosis study
D: Inclusion Criteria:

* age \> 50 years
* any closed distal forearm fracture
* discharged home

Exclusion Criteria:

* unwilling or unable to provide consent
* admitted to hospital
* long term care resident
* residence outside Edmonton, Alberta
* unable to read and converse in English
* currently taking prescription osteoporosis treatment

Answer: D