Effectiveness or Orthopedic Intervention in Osteoporosis Management After a Fracture of the Hip With Cost-Benefit Analysis
Condition: Osteoporotic Fracture
MeSH terms: Osteoporosis; Fractures, Bone; Osteoporotic Fractures
Study type: Interventional

Summary: 
      Patients who present with fragility fractures are consistently under-evaluated and
      under-treated for underlying osteoporosis. This point of care represents a lost opportunity
      to prevent future fractures. The medical field treats the fracture as if the fall is the
      problem, but bone quality is the real problem. Studies have consistently shown that the
      recommendations of the International Osteoporosis Foundation and World Health Organization
      are not being followed. Orthopedics treats the patients for their fractures and primary care
      physicians focus on general health but no one is taking responsibility for bone health.
      Strategies to convince primary care to assume care have not succeeded. On the other hand,
      strategies where orthopedics takes some responsibility have shown success. This prospective
      2-arm study will evaluate the success of effort by an academic orthopedic department in
      osteoporosis evaluation and treatment. We hypothesize that with greater effort by the
      orthopedic department, the better the adherence to standards of care. A cost benefit analysis
      will be made in parallel.
    

Detailed description: 
      Patients who present to the orthopedic department in a level I trauma center will be
      prospectively randomized into one of two groups:

      Letter Group: At time of discharge, patients will be sent home with a discharge letter that
      includes standard recommendations for evaluation and treatment. They will be asked to give
      the letter to their primary care physician.

      Intervention Group: There will be 4 interventions. The patient will be given a short pamphlet
      with explaining osteoporosis and the importance of treatment. The orthopedic department will
      perform a bone density testing (DEXA). They will be given a letter with a specific medication
      recommendation based on a protocol determined by our endocrinology department. They will be
      asked to give both DEXA and medication recommendation to their primary care doctor to
      initiate treatment. Finally, a research assistant will contact the patient monthly to
      encourage them to start treatment.
    

Intervention name(s): Letter Group; Intervention Group
Intervention type(s): Procedure; Procedure
Intervention description(s): At time of discharge from the hospital, patients will be sent home with a letter that includes standard recommendations for evaluation and treatment for osteoporosis. This will be asked to give the letter to their primary care physician.; The orthopedic department will be responsible for arranging bone density testing (DEXA) and recommending specific medication after discharge. A research assistant will call monthly to encourage treatment.
Other intervention name(s): Intervention; Dual-energy X-ray absorptiometry; Bone density scan; Bisphosphonate; Prolia; Denosumab; Forteo; Teriparatide
Intervention MeSH terms: Denosumab; Teriparatide; Diphosphonates
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Pathologic fracture; Insufficiency fracture; Secondary fracture; Fracture with bone fragility; Osteoporosis; Bone loss; Osteopenia; Metabolic Bone Disease; Fragility fracture