Background Patients with osteoporotic fractures have an increased likelihood of a future fracture. Only 3% to 5% of hip, wrist or vertebral fracture patients are diagnosed for osteoporosis (OP) and treated. Thus it is vital to promptly initiate secondary prevention of OP. Early assessment and application of secondary prevention of OP fracture is defined as treatment of OP and fall prevention strategies following a fragility fracture. Given the high risk of refracture among older adults with fracture, it is important to initiate secondary treatment of OP. Fracture clinics may offer a unique setting to assess and initiate management.
Objectives To assess the efficacy of screening, initiation of OP treatment and fall prevention strategies in an acute setting compared to the usual standard setting.
Methods This prospective randomized trial included 82 patients (63 females, 19 males), mean age 66.5 years presenting with a suspected fracture to the emergency department of the main university hospital and to the outpatient clinic of the orthopaedics department. Patients were randomized into 2 groups, the fracture clinic (FC) intervention group (n= 41) and the usual standard setting control group (n= 41) and followed up for 6 months. Exclusion criteria: pathological fracture and creatinine clearance < 30mg/dl. Interventions in the FC group consisted of initial dual energy x-ray absorptiometry (DEXA) scan assessments, pharmacological and non-pharmacological interventions for the secondary prevention of OP. Interventions included a 6-month treatment regimen of an oral bisphosphonate, calcium and vitamin D. Fall prevention measures offered to patients included visual acuity assessment, medication review, personalized strength and flexibility exercises and a home hazards assessment. The acute setting fracture clinic management was compared to the standard usual care initiated in the primary care setting.
Results Assessment (DEXA scan rate) was significantly more in the intervention group where patients were referred for assessment from the FC compared to the control group where patients were referred for assessment by their primary care physician (71% versus 32% respectively, p < 0.005. Early treatment initiation rates in the FC group were significantly greater than treatment rates in the usual primary care setting. Furthermore, 6-month compliance in the FC group was greater than in the control group. At 6 months, among patients in the intervention group, compliance to medications was 76% versus 51% in the control group. Fall prevention strategies were adhered to in 83% of the FC group.
Conclusions The present study shows that OP screening and treatment initiation in the acute setting results in improved management and compliance compared to the primary care setting. Health care professionals should be vigilant concerning the early assessment and initiation of OP treatment in all settings including the acute care setting that serves to provide a unique opportunity to overcome many obstacles in the assessment, initiation and management of OP.
Disclosure of Interest None Declared
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