Controlled Trial to Increase Detection and Treatment of Osteoporosis in Older Patients With a Wrist Fracture

Study Overview
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Brief Summary
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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.

Detailed Description
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BACKGROUND: Osteoporosis is a progressive condition that causes a loss of bone mass, skeletal fragility, and fractures. Fractures result in pain, disability, deformity, and death. Osteoporosis is a major population health problem affecting 1.4 million Canadians, 25% of women and 12% of men over the age of 50 years. Current guidelines recommend aggressive secondary prevention in patients with osteoporosis who have suffered a fracture, because these patients have as high as a 20% risk of fracture in the following year, and because there are now proven efficacious treatments that can reduce this risk by 40-60%. Nevertheless, recent studies have shown that these patients are under-recognized and under-treated, demonstrating a care gap between evidence-based best practice and usual care. All patients with osteoporotic fractures (i.e., of the hip, vertebrae, or wrist) benefit from treatment. However, patients who present with a wrist fracture may be best suited to an intervention to improve secondary prevention practices, because wrist fractures are sentinel events in the natural history of osteoporosis: they are common, easily diagnosed, always present to medical attention, and occur years before the more devastating and costly fractures of the hip and vertebrae. OBJECTIVES: The primary objective of this study is to improve the quality of care for patients who present to the ED 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 replacement therapy, a bisphosphonate, raloxifene, or calcitonin within 6 months of a fracture of the wrist. HYPOTHESIS: A quality improvement intervention directed at patients and their primary care physicians will increase the use of proven efficacious osteoporosis treatment. The intervention itself has multiple components that include: a notification system and patient-specific reminders for primary care physicians, locally developed treatment guidelines endorsed by opinion leaders, and patient education and counseling. The study hypothesis will be tested by comparing the intervention to usual care controls, in a prospective nonrandomized controlled trial. SPECIFIC AIMS: To determine whether the proposed intervention can- 1. Increase the use of proven efficacious osteoporosis treatment in patients with a fracture of the wrist, 2. Increase appropriate use of bone mineral density testing, 3. Increase patients' knowledge of osteoporosis and satisfaction.

Official Title
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Controlled Trial to Increase Detection and Treatment of Osteoporosis in Older Patients With a Wrist Fracture

Conditions
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Osteoporosis, Wrist Fractures

Intervention / Treatment
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* Behavioral: Multifaceted intervention (patient education, physician guidelines, reminders)


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Multifaceted intervention (patient education, physician guidelines, reminders)|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Increased use of proven efficacious osteoporosis treatment within six months of study enrollment, defined as: hormone therapy, a bisphosphonate, raloxifene, or calcitonin. |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 1. BMD testing |  |  | 
| 2. Osteoporosis diagnosis |  |  | 
| 3. Osteoporosis related knowledge |  |  | 
| 4. Satisfaction |  |  | 
| 5. Generic, Disease Specific, and Function-related QOL |  |  | 
| 6. Falls, falls-related injuries, and fall interventions |  |  | 
| 7. Persistence of effects and generalizability of effects |  |  | 
| 8. 1, 2, 3 year outcomes |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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osteoporosis, wrist fractures, quality improvement, knowledge translation