Conclusions All interventions produced positive effects on BMD scanning and osteoporosis treatment rates post-fracture .
Despite sizeable increases , investigation and treatment rates remain sub-optimal .
Background There is a large quality of care gap for patients with osteoporosis .
As a fragility fracture is a strong indicator of underlying osteoporosis , it offers an ideal opportunity to initiate investigation and treatment .
However , studies of post-fracture population s document screening and treatment rates below 20 % in most setting s. This is despite the fact that bone mineral density ( BMD ) scans are effective at identifying patients at high risk of fracture , and effective drug treatments are widely available .
Effective interventions are required to remedy this incongruity in current practice .
Effect of a case-finding strategy for osteoporosis on bisphosphonate prescribing in primary care
Case- selection strategies have been advocated for identifying patients who would benefit from primary care to prevent osteoporosis . However , the effectiveness of this approach is unclear . To address this question , we performed a r and omized control trial to determine whether a case- selection strategy to identify patients with clinical risk factors for osteoporosis , combined with open access to dual X-ray absorptometry ( DXA ) scans  , influences bisphosphonate prescribing in ten GP practice s in Avon . Practice s were r and omized to two groups : the first identified women aged 45–75 years at high risk of osteoporosis and provided open access to DXA scans for 12 months ; the second had no case-finding strategy and no DXA scan access . Bisphosphonate prescribing was ascertained by search ing computerized patient records every 3 months during the intervention and a subsequent 6-month follow-up period . Overall , the number of subjects in each practice who were prescribed bisphosphonates  increased by 50 % ( p<0.001 ) , and the proportion of bisphosphonates prescribed as aminobisphosphonates  increased 3-fold ( p<0.001 ) . The magnitude of these changes was similar in both groups . However , of the patients prescribed bisphosphonates , approximately twice as many in group 1 , as compared with group 2 , had a previously documented low-trauma fracture , as assessed at the end of the 12-month intervention period ( p=0.01 ) . Furthermore , at study ’s end , of the 30 patients in group 1 receiving bisphosphonates who had received DXA scans , 80 % had osteoporosis as defined by t-score<-2.5 . We conclude that use of a case- selection strategy for osteoporosis in primary care , combined with open access to DXA scans , appears to target bisphosphonate therapy to those at high risk of osteoporotic fractures . In contrast , the overall rate of bisphosphonate prescribing is unaffected by this intervention
Conclusions All interventions produced positive effects on BMD scanning and osteoporosis treatment rates post-fracture .
Despite sizeable increases , investigation and treatment rates remain sub-optimal .
Background There is a large quality of care gap for patients with osteoporosis .
As a fragility fracture is a strong indicator of underlying osteoporosis , it offers an ideal opportunity to initiate investigation and treatment .
However , studies of post-fracture population s document screening and treatment rates below 20 % in most setting s. This is despite the fact that bone mineral density ( BMD ) scans are effective at identifying patients at high risk of fracture , and effective drug treatments are widely available .
Effective interventions are required to remedy this incongruity in current practice .