Simple interventions boost vertebral fracture osteoporosis care

By Lynda Williams, Senior medwireNews Reporter

Use of osteoporosis investigation and treatment is significantly increased in older patients with asymptomatic vertebral fracture by use of physician- and patient-targeted interventions, Canadian research suggests.

Of 240 patients with a vertebral fracture detected incidentally during a chest radiograph at an emergency department, those whose family physician was given opinion-leader-endorsed summaries and reminders were significantly more likely to receive bone mineral density (BMD) testing (44 vs 4%) and osteoporosis treatment (17 vs 2%) within 3 months than those assigned to receive usual care. The combined rate for BMD assessment or treatment was 49% and 6% for the groups, respectively.

All untreated controls were then reallocated to receive the physician intervention combined with a patient-targeted intervention consisting of leaflets and telephone counseling. At 3 months, 65% had undergone BMD testing, 22% had begun treatment, and 65% had initiated one or the other.

This translates to a significant 16% increase in osteoporosis diagnosis or treatment with the physician-patient intervention over the improvement achieved by the physician-directed intervention, report Sumit Majumdar and co-workers from the University of Alberta in Edmonton.

They note that the number needed to treat to improve osteoporosis diagnosis or treatment after incidental vertebral fracture detection was just two for either intervention.

"Even with the interventions studied, most (80%) study subjects remained untreated for osteoporosis, and our study is limited by the fact that we do not know what the achievable rates of treatment ought to be or the reasons that physicians or patients might have chosen to forgo treatment," the researchers comment in the American Journal of Medicine.

They explain that such reasons could include short life expectancy or osteoporosis medication contraindications, including kidney disease, risk factors for osteonecrosis of the jaw, or polypharmacy concerns.

"Collectively, such issues might lead pragmatic physicians and their informed patients to appropriately forgo or delay osteoporosis treatment, and so we estimate that benchmark rates of osteoporosis treatment in our study setting should be at least 60%-70%-and certainly far greater than the 2% rates currently achieved with usual care," the team writes.

Majumdar et al conclude: "Both interventions were simple and inexpensive and, until future studies are completed to determine methods that are more effective, we believe that the interventions tested here could be safely and effectively implemented in other settings."

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