Facilitated bone mineral density testing versus hospital-based case management to improve osteoporosis treatment for hip fracture patients: Additional results from a randomized trial

Authors

  • Donald W. Morrish,

    Corresponding author
    1. University of Alberta, Edmonton, Alberta, Canada
    • Department of Medicine, 362 Heritage Medical Research Center, University of Alberta, Edmonton, Alberta, Canada, T6G 2S2
    Search for more papers by this author
    • Drs. Morrish and Beaupre contributed equally to this work.

    • Dr. Morrish has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Novartis, Wyeth, and Amgen, and has received an unrestricted research grant from Sanofi-Aventis.

  • Lauren A. Beaupre,

    1. University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
    • Drs. Morrish and Beaupre contributed equally to this work.

  • Neil R. Bell,

    1. University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • John G. Cinats,

    1. University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • David A. Hanley,

    1. University of Calgary, Calgary, Alberta, Canada
    Search for more papers by this author
    • Dr. Hanley has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Merck Frosst, Procter and Gamble, Sanofi-Aventis, and Novartis.

  • Charles H. Harley,

    1. University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • Angela G. Juby,

    1. University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
    • Ms Juby has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Novartis, Eli Lilly, Procter and Gamble, Sanofi, Wyeth, Merck Frosst, and Amgen.

  • Douglas A. Lier,

    1. University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • Walter P. Maksymowych,

    1. University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
    • Dr. Maksymowych is recipient of a Scientist award from the Alberta Heritage Foundation for Medical Research.

  • Sumit R. Majumdar

    1. University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
    • Dr. Majumdar is recipient of a Health Scholar award from the Alberta Heritage Foundation for Medical Research and a New Investigator award from the Canadian Institutes of Health Research.


  • ClinicalTrials.gov identifier: NCT00175175.

Abstract

Objective

We previously demonstrated that a case manager intervention improved osteoporosis (OP) treatment within 6 months of hip fracture compared with usual care. The second phase of the randomized trial compared a less intensive intervention, facilitated bone mineral density (BMD) testing, with usual care and the case manager intervention.

Methods

We initially randomized 220 hip fracture patients to either an OP case manager intervention or usual care. After completing the original trial at 6 months postfracture, usual care patients were reallocated to facilitated BMD testing; BMD tests were arranged and results sent to primary care physicians. Main outcomes (bisphosphonate treatment, BMD tests, receipt of appropriate care) were reascertained 1 year following hip fracture and compared with outcomes achieved by the OP case manager intervention and usual care.

Results

Compared with usual care, facilitated BMD testing increased testing from 29% to 68% (P < 0.001), bisphosphonate use from 22% to 38% (P < 0.001), and receipt of appropriate care from 26% to 45% (P < 0.001). The more intensive (70 versus 30 minutes) and expensive ($56 versus $24 Canadian per patient) OP case manager intervention led to significantly higher bisphosphonate use (54% versus 38%; P = 0.03), receipt of appropriate care (71% versus 45%; P < 0.001), and more BMD testing (80% versus 68%; P = 0.06) than usual care followed by facilitated BMD testing.

Conclusion

Compared with usual care, 2 different inexpensive interventions resulted in significant increases in appropriate management of OP after hip fracture. The magnitude of improvements achieved was directly related to the intensity of the interventions.

Ancillary