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01-03-2017 | Original Article

Addition of a fracture risk assessment to a coordinator’s role improved treatment rates within 6 months of screening in a fragility fracture screening program

Authors: D. E. Beaton, M. Vidmar, K. B. Pitzul, R. Sujic, N. K. Rotondi, E. R. Bogoch, J. E. M. Sale, R. Jain, J. Weldon

Published in: Osteoporosis International | Issue 3/2017

Abstract

Summary

We evaluated the impact of a more intensive version of an existing post-fracture coordinator-based fracture prevention program and found that the addition of a full-risk assessment improved treatment rates. These findings provide additional support for more intensive programs aimed at reducing the risk of re-fractures.

Introduction

Evidence-based guidelines support coordinator-based programs to improve post-fracture osteoporosis guideline uptake, with more intensive programs including bone mineral density (BMD) testing and/or treatment being associated with better patient outcomes. The purpose of this study was to evaluate the impact of a more intensive version (BMD “fast track”) of an existing provincial coordinator-based program.

Methods

We compared two versions of the program that screened treatment naïve fragility fracture patients (>50 years). Cases came from the BMD fast track program that included full fracture risk assessment and communication of relevant guidelines to the primary care provider (PCP). Matched controls were selected from the usual care program matching according to age, sex, fracture type, and date. Two matching techniques were used: traditional (hard) matching (TM) and propensity score matching (PS). The outcomes were treatment initiation with bone sparing medication, BMD testing rate, and the rate of returning to discuss the test results with a PCP.

Results

The program improvements led to a significant improvement in treatment initiation within 6 months from 16 % (controls based on PS) or 21 % (controls based on TM) to 32 % (cases). Ninety percent of patients in the BMD fast track program returned to their PCP to discuss bone health in the cases versus 60 % of the controls (for TM and PS). BMD testing occurred in 96 % of cases compared to the 66 (TM) or 65 % (PS) of the matched controls.

Conclusions

Addition of a full-risk assessment to a coordinator-based program significantly improved treatment rates within 6 months of screening.

Kanis JA, Johnell O, De LC, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382CrossRefPubMed

Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C (2002) Meta-analyses of therapies for postmenopausal osteoporosis. IX: summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 23:570–578CrossRefPubMed

Bogoch ER, Elliot-Gibson V, Escott BG, Beaton DE (2008) The osteoporosis needs of patients with wrist fracture. J Orthop Trauma 22:S73–S78CrossRefPubMed

Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305CrossRefPubMed

Morrish DW, Beaupre LA, Bell NR, Cinats JG, Hanley DA, Harley CH, Juby AG, Lier DA, Maksymowych WP, Majumdar SR (2009) Facilitated bone mineral density testing versus hospital-based case management to improve osteoporosis treatment for hip fracture patients: additional results from a randomized trial. Arthritis Rheum 61:209–215CrossRefPubMed

Siris ES, Bilezikian JP, Rubin MR, Black DM, Bockman RS, Bone HG, Hochberg MC, McClung MR, Schnitzer TJ (2003) Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab 88:3482–3486CrossRefPubMed

Solomon DH, Finkelstein JS, Katz JN, Mogun H, Avorn J (2003) Underuse of osteoporosis medications in elderly patients with fractures. Am J Med 115:398–400CrossRefPubMed

Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24:393–406CrossRefPubMed

Sale JE, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2011) Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporos Int 22:2067–2082CrossRefPubMed

10.

Dell R, Greene D (2010) Is osteoporosis disease management cost effective? Curr Osteoporos Rep 8:49–55CrossRefPubMed

11.

Majumdar SR, Lier DA, Leslie WD (2013) Cost-effectiveness of two inexpensive postfracture osteoporosis interventions: results of a randomized trial. Journal of Clinical Endocrinology & Metabolism 98:1991–2000CrossRef

12.

Majumdar SR, Lier DA, Beaupre LA, Hanley DA, Maksymowych WP, Juby AG, Bell NR, Morrish DW (2009) Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med 169:25–31CrossRefPubMed

13.

Majumdar SR, Johnson JA, Lier DA, Russell AS, Hanley DA, Blitz S, Steiner IP, Maksymowych WP, Morrish DW, Holroyd BR, Rowe BH (2007) Persistence, reproducibility, and cost-effectiveness of an intervention to improve the quality of osteoporosis care after a fracture of the wrist: results of a controlled trial. Osteoporos Int 18:261–270CrossRefPubMed

14.

McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22:2083–2098CrossRefPubMed

15.

Sander B, Elliot-Gibson V, Beaton DE, Bogoch ER, Maetzel A (2008) A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. J Bone Joint Surg Am 90:1197–1205CrossRefPubMed

16.

Beaton DE, Sujic R, Jiang D, Sale J, Bogoch E (2009) Outcomes of the province-wide Post Fracture Osteoporosis Screening Program. American Society for Bone and Mineral Research, 31st Annual Meeting, Denver, Colorado

17.

Beaton DE, Sujic R, McIlroy BK, Sale J, Elliot-Gibson V, Bogoch ER (2012) Patient perceptions of the path to osteoporosis care following a fragility fracture. Qual Health Res 22:1647–1658CrossRefPubMed

18.

Beaton DE, Dyer S, Jiang D, Slater M, Sale JEM, Bogoch E (2014) Factors influencing the pharmacological management of osteoporosis after a fragility fracture: results from the Ontario osteoporosis strategy’s fracture clinic screening program. Osteoporos Int 25:289–296CrossRefPubMed

19.

Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873CrossRefPubMedPubMedCentral

20.

Beaton DE, Mamdani M, Zheng H, Jaglal S, Cadarette SM, Jain R, et al. (2013) Impact of a case finding intervention on fracture risk reduction outcomes following fragility fractures. Presented at The 2nd Fragility Fracture Network Global Congress. Berlin, Germany

21.

Yong JH, Masucci L, Hoch JS, Sujic R, Beaton D (2016) Cost-effectiveness of a fracture liaison service: a real-world evaluation after 6 years of service provision. Osteoporos Int 27(1):231–40. doi:10.1007/s00198-015-3280-1

22.

Sujic R, Gignac MA, Cockerill R, Beaton DE (2013) Factors predictive of the perceived osteoporosis-fracture link in fragility fracture patients. Maturitas 76:179–184CrossRefPubMed

23.

Baim S, Leslie WD (2012) Assessment of fracture risk. Current Osteoporosis Reports 10:28–41CrossRefPubMed

24.

Lentle B, Cheung AM, Hanley DA, Leslie WD, Lyons D, Papaioannou A, Atkinson S, Brown JP, Feldman S, Hodsman AB, Jamal AS, Josse RG, Kaiser SM, Kvern B, Morin S, Siminoski K (2011) Osteoporosis Canada 2010 guidelines for the assessment of fracture risk. Can Assoc Radiol J 62:243–250CrossRefPubMedPubMedCentral

25.

Austin PC (2008) A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 27:2037–2049CrossRefPubMed

26.

Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55CrossRef

27.

Stuart EA (2010) Matching methods for causal inference: a review and a look forward. Stat Sci 25:1–21CrossRefPubMedPubMedCentral

28.

Glynn RJ, Schneeweiss S, Sturmer T (2006) Indications for propensity scores and review of their use in pharmacoepidemiology. Basic Clin Pharmacol Toxicol 98:253–259CrossRefPubMedPubMedCentral

29.

Rosenbaum PR, Rubin DB (1985) Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. American Statistical Association 39:33–38

30.

Ury HK (1975) Efficiency of case-control studies with multiple controls per case: continuous or dichotomous data. Biometrics 31:643–649CrossRefPubMed

31.

Huntjens KM, Kosar S, van Geel TA, Geusens PP, Willems P, Kessels A, Winkens B, Brink P, van Helden S (2010) Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture. Osteoporos Int 21(12):2075–82. doi:10.1007/s00198-010-1178-5

32.

Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley D, Hodsman A, Jamal SA, Josse RG, Kaiser SM, Kvern B, Siminoski K, Leslie WD, for the Scientific Advisory Council of Osteoporosis Canada (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Backgroud and Technical Report

33.

Cadarette SM, Jaglal SB, Raman-Wilms L, Beaton DE, Paterson JM (2010) Osteoporosis quality indicators using healthcare utilization data. Osteoporos Int 22:1335–1342CrossRefPubMedPubMedCentral

34.

Tinetti ME, Gordon C, Sogolow E, Lapin P, Bradley EH (2006) Fall-risk evaluation and management: challenges in adopting geriatric care practices. Gerontologist 46:717–725CrossRefPubMed

35.

Rozental TD, Makhni EC, Day CS, Bouxsein ML (2008) Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am 90:953–961CrossRefPubMed

Title: Addition of a fracture risk assessment to a coordinator’s role improved treatment rates within 6 months of screening in a fragility fracture screening program
Authors: D. E. Beaton
M. Vidmar
K. B. Pitzul
R. Sujic
N. K. Rotondi
E. R. Bogoch
J. E. M. Sale
R. Jain
J. Weldon
Publication date: 01-03-2017
Publisher: Springer London
Published in: Osteoporosis International / Issue 3/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-016-3794-1

At a glance: The STEP trials

Springer Medicine

Addition of a fracture risk assessment to a coordinator’s role improved treatment rates within 6 months of screening in a fragility fracture screening program

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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