Secondary Prevention of Osteoporosis

Study Overview
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Brief Summary
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The purpose of this study is to develop and implement an evidence based protocol for the secondary prevention of osteoporotic fractures and falls, and to determine how compliance with this intervention improves muscle strength and functional status following a fracture.

Detailed Description
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Following a fracture, few persons are screened or treated for osteoporosis (Feldstein et al). It is not surprising, then, that the risk of future osteoporotic fractures remains high. Although little data exists on the secondary prevention of osteoporosis, calcium, vitamin D, and bisphosphonates have all been shown to be effective in the primary prevention of osteoporotic fractures, and they are likely beneficial in reducing secondary fractures as well. Targeting falls prevention is another approach that is likely effective in reducing the risk of fracture. In the U.S., acute rehabilitation (rehab) settings offer a unique environment to initiate osteoporotic therapy. Therefore, this study will develop and implement evidence based interventions for the secondary prevention of osteoporotic fractures in the acute rehab setting with the following objectives: Specific Aim I: Assess overall compliance with pharmacological and non-pharmacological interventions initiated in an acute rehab setting following a fragility fracture. Hypothesis: Non-compliant participants are less likely to show improvement in functional status, muscle strength, or vitamin D levels following the intervention. Specific Aim II: Describe the incidence of fragility fractures and falls in participants at 6-months and one-year following the osteoporotic intervention introduced during acute rehab. Hypothesis: Similar to community based studies, a number of participants will go on to experience repeat falls and resulting fractures within one-year of follow-up. Compliant participants are less likely to experience falls and fractures. Specific Aim III: Confirm the high prevalence of vitamin D deficiency in a rehab setting. Describe the relationship between changes in vitamin D levels in participants between baseline and 6-month follow-up and changes in functional outcomes. Hypothesis: There will be a direct association between a change in vitamin D levels and a change in functional status. Consecutive individuals admitted with the primary or secondary diagnosis of fracture in the rehabilitation unit of Hebrew Rehabilitation Center will be offered enrollment. All participants enrolled will receive the same intervention: calcium, vitamin D, a weekly oral bisphosphonate, and falls prevention interventions. Specific interventions for preventing falls include optimization of visual acuity, a review of medications associated with falls, personalized exercises to improve strength and balance, and a home hazards safety evaluation when indicated. All participants will have their functional status, muscle strength, and vitamin D level measured at baseline during their rehab stay. At the six-month follow-up, a home visit will be performed for all participants to again assess functional status, muscle strength, vitamin D level, satisfaction with the intervention, and reasons for non-compliance. A history of interim falls and fractures will be collected by telephone interviews, during home nursing visits, and during the exit 6-month visit.

Official Title
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Secondary Prevention of Osteoporosis: A Window of Opportunity in the Acute Rehabilitation Setting

Conditions
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Osteoporosis

Intervention / Treatment
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* Drug: alendronate with cholecalciferol
* Drug: calcium carbonate with cholecalciferol
* Behavioral: Falls prevention measures


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Admitted to rehab unit with the primary or secondary diagnosis of fracture English speaking Cognitively able to provide consent or health care proxy available and willing to provide consent Willing to cooperate Exclusion Criteria: Pathologic or periprosthetic fractures Creatinine clearance less than 15ml/minute Severe hypocalcemia Esophageal stricture or achalasia Taking other treatment for osteoporosis besides calcium or vitamin D in the past 6-months History of kidney stones in the past 6-months

Ages Eligible for Study
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Minimum Age: 65 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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Treatment for osteoporosis and falls<br>calcium, vitamin D, a weekly oral bisphosphonate, and falls prevention measures. No comparator group. All participants received the same intervention | Drug: alendronate with cholecalciferol<br>* alendronate 70mg /cholecalciferol 2800IU orally once weekly<br>* Other names: Fosamax Plus D®;Drug: calcium carbonate with cholecalciferol<br>* calcium carbonate 500mg /cholecalciferol 200IU orally twice daily<br>* Other names: Os-Cal with extra D;Behavioral: Falls prevention measures<br>* personalized exercises, home safety evaluation, referral to an eye doctor if needed, review of medications<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number Adherent With the Intervention |  | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reasons for Non-willingness to Particiapte and Non-adherence With Intervention | We asked participants who would not participate the primary reason for non-particiaption. We also asked participants who were not adherent with recommendations what the primary reason ws for non-adherence. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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disease/disorder proneness/risk, osteoporotic fractures, accidental falls, aging