Compliance and persistence to oral bisphosphonate therapy following initiation within a secondary fracture prevention program: a randomised controlled trial of specialist vs. non-specialist management Randomized trial to improve fracture prevention in nursing home residents. A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal Fracture prevention service to bridge the osteoporosis care gap Effects of medication reviews performed by a physician on treatment with fracture-preventing and fall-risk-increasing drugs in older adults with hip fracture-a randomized controlled study. Educating nursing home staff on fracture prevention: a cluster randomised trial. Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes. Low acceptance of treatment in the elderly for the secondary prevention of osteoporotic fracture in the acute rehabilitation setting Primary and secondary non-adherence to osteoporotic medications after hip fracture in Spain. The PREV2FO population-based retrospective cohort study To evaluate the effectiveness of a discharge-planning programme for hip fracture patients. Effectiveness and acceptability of a newly designed hip protector: a pilot study. Cost-effectiveness of a multifactorial fall prevention program in nursing homes Initiation of osteoporosis assessment in the fracture clinic results in improved osteoporosis management: a randomised controlled trial Randomized controlled trial of a primary care–based screening program to identify older women with prevalent osteoporotic vertebral fractures: Cohort for skeletal health in Bristol and Avon (COSHIBA) 3-D bone models to improve treatment initiation among patients with osteoporosis: A randomised controlled pilot trial Predicting a second hip fracture.
Summary Following initiation of oral bisphosphonate therapy through a secondary fracture prevention program , 2-year treatment compliance and persistence remained high and were similar in patients r and omised to follow-up by either the program or primary care physician . Thus , community-based and specialist management are equally effective in supporting compliance and persistence with anti-osteoporotic treatments . Introduction The purpose of this study was to determine whether management by a secondary fracture prevention ( SFP ) program ( aka “ fracture liaison service ” ) results in better compliance and persistence to oral bisphosphonate therapy than follow-up by the primary care physician , after initiation within an SFP program . Methods This prospect i ve RCT included 102 patients with incident osteoporotic fractures referred to a SFP program in Sydney , Australia . Following oral bisphosphonate therapy initiation , patients were r and omised to either 6-monthly follow-up with the SFP program ( group A ) or referral to their primary care physician with a single SFP program visit at 24 months ( group B ) . Compliance and persistence to treatment were measured using pharmaceutical cl aims data . Predictors of compliance and persistence and associations between compliance and persistence , and changes in bone mineral density ( BMD ) or bone resorption marker , urinary deoxypyridinoline over 24 months were analysed . Results The median medication possession ratio at 24 months was 0.78 ( IQR , 0.50–0.93 ) in group A and 0.79 ( IQR , 0.48–0.96 ) in group B ( p = 0.68 ) . Persistence at 24 months was also similar in both groups ( 64 vs. 61 % , respectively ; p = 0.75 ) . After adjusting for confounders , patients in group A were not more likely to be compliant ( OR , 1.06 ; 95 % CI , 0.46–2.47 ) or persistent ( HR , 0.83 ; 95 % CI , 0.27–1.67 ) than those r and omised to group B. Time-based changes in BMD or bone turnover were not associated with compliance or persistence . Conclusion Compliance and persistence to oral bisphosphonate therapy remain high amongst patients initiated within an SFP program , with community-based and SFP program management being equally effective in maintaining therapeutic compliance and persistence over 2 years . These results indicate that one of the main functions of an SFP program may be the initiation of therapy rather than continuous patient monitoring BACKGROUND Interventions to improve the fracture prevention in nursing homes are needed . METHODS Cluster-r and omized , single-blind , controlled trial of a multi-modal quality improvement intervention .  Nursing homes ( n=67 ) with > or = 10 residents with a diagnosis of osteoporosis or recent hip fracture ( n=606 ) were r and omized to receive an early or delayed intervention consisting of audit and feedback , educational modules , teleconferences , and academic detailing . Medical record abstract ion and the Minimum Data Set were used to measure the prescription of osteoporosis therapies before and after the intervention period . Analysis was at the facility-level and Generalized Estimating Equation modeling was used to account for clustering . RESULTS No significant improvements were observed in any of the quality indicators . The use of osteoporosis pharmacotherapy or hip protectors improved by 8.0 % in the intervention group and 0.6 % in the control group , but the difference was not statistically significant ( P=.72 ) . Participation in the intervention activities was low , but completion of the educational module ( odds ratio [ OR ] 4.8 , 95 % confidence interval [ CI ] , 1.9 - 12.0 ) and direct physician contact by an academic detailer ( OR 4.5 , 95 % CI , 1.1 - 18.2 ) were significantly associated with prescription of osteoporosis pharmacotherapy or hip protectors in multivariable models . CONCLUSIONS Audit-feedback and education interventions were ineffective in improving fracture prevention in the nursing home setting , although results may have been tempered by low participation in the intervention activities Summary We tested the feasibility of a fracture prevention decision aid in an online patient portal . The decision aid was acceptable for patients and successfully decreased decisional conflict . This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care . Introduction Although interventions have improved osteoporosis screening and /or treatment for certain population s of high-risk patients , recent national studies suggest that large-scale uptake of these interventions has been limited . We aim ed to determine the feasibility and potential efficacy of a patient portal-based osteoporosis decision aid ( DA ) . Methods We conducted a pilot r and omized controlled trial of primary care patients aged ≥55 who were enrolled in a patient portal and had a T-score of < −1 . Intervention subjects were provided a link to a patient DA . The DA contained a 10-year fracture risk calculator , summary of medication risks and benefits ( prescription and nonprescription ) , and an elicitation of values . Subjects completed question naires assessing the primary outcomes of decisional conflict and preparation for decision making and secondary outcomes related to feasibility and planning for a larger trial . Charts were review ed for physician-subject interactions and medication uptake . Results The DA was acceptable to subjects , but 17 % of the patients in the decision aid arm incorrectly entered their T-scores into FRAX-based risk calculator . Decisional conflict was lower post-intervention for those who were r and omized to the decision aid arm compared to controls ( 17.8 vs. 47.1 , p < .001 ) , and there was a significant difference in the percentage of patients who made a treatment decision at 3 months . No significant differences were observed in medication uptake . Conclusions A portal-based osteoporosis DA  was acceptable and improved several measures of decision quality . Given its effect on improving the quality of patients ’ decisions , future studies should examine whether it improves physician guideline adherence or medication adherence uptake among treated patients Background A care gap exists between the health care needs of older persons with fragility fractures and the therapeutic answers they receive . The Fracture Prevention Service ( FPS ) , a tailored in-hospital model of care , may effectively bridge the osteoporosis care gap for hip-fractured older persons . The purpose of this study was to evaluate the efficacy of the FPS in targeting persons at high risk of future fracture and to improve their adherence to treatment . Methods This was a prospect i ve observational study conducted in a teaching hospital with traumatology and geriatric units , and had a pre-intervention and post-intervention phase . The records of 172 participants were evaluated in the pre-intervention phase , while data from 210 participants were gathered in the post-intervention phase . All participants underwent telephone follow-up at 12 months after hospital discharge . The participants were patients aged ≥65 years admitted to the orthopedic acute ward who underwent surgical repair of a proximal femoral fracture . A multidisciplinary integrated model of care was established . Dedicated pathways were implemented in clinical practice to optimize the identification of high-risk persons , improve their evaluation through bone mineral density testing and blood examinations , and initiate an appropriate treatment for secondary prevention of falls and fragility fractures . Results Compared with the pre-intervention phase , more hip-fractured persons received bone mineral density testing ( 47.62 % versus 14.53 % , P<0.0001 ) , specific pharmacological treatments ( 48.51 % versus 17.16 % , P<0.0001 ) , and an appointment for evaluation at a fall and fracture clinic ( 52.48 % versus 2.37 % , P<0.0001 ) in the post-intervention phase . Independent of some confounders , implementation of the FPS was positively associated with recommendations for secondary fracture prevention at discharge ( P<0.0001 ) and with 1-year adherence to pharmacological treatment ( P<0.0001 ) . Conclusion The FPS is an effective multidisciplinary integrated model of care to optimize identification of older persons at highest risk for fragility fracture , to improve their clinical management , and to increase adherence to prescriptions OBJECTIVES To investigate whether medication review s increase treatment with fracture-preventing drugs and decrease treatment with fall-risk-increasing drugs . DESIGN R and omized controlled trial ( 1:1 ) . SETTING Departments of orthopedics , geriatrics , and medicine at Sahlgrenska University Hospital , Gothenburg , Sweden . PARTICIPANTS One hundred ninety-nine consecutive individuals with hip fracture aged 65 and older . INTERVENTION Medication review s , based on assessment s of risks of falls and fractures , regarding fracture-preventing and fall-risk-increasing drugs , performed by a physician , conveyed orally and in written form to hospital physicians during the hospital stay , and to general practitioners after discharge . MEASUREMENTS Primary outcomes were changes in treatment with fracture-preventing and fall-risk-increasing drugs 12 months after discharge . Secondary outcomes were falls , fractures , deaths , and physicians ' attitudes toward the intervention . RESULTS At admission , 26 % of intervention and 29 % of control participants were taking fracture-preventing drugs , and 12 % and 11 % , respectively , were taking bone-active drugs , predominantly bisphosphonates . After 12 months , 77 % of intervention and 58 % of control participants were taking fracture-preventing drugs ( P = .01 ) , and 29 % and 15 % , respectively , were taking bone-active drugs ( P = .04 ) . Mean number of fall-risk-increasing drugs per participants was 3.1 ( intervention ) and 3.1 ( control ) at admission and 2.9 ( intervention ) and 3.1 ( control ) at 12 months ( P = .62 ) . No significant differences in hard endpoints were found . The responding physicians ( n = 65 ) appreciated the intervention ; on a scale from 1 ( very bad ) to 6 ( very good ) , the median rating was 5 ( interquartile range ( IQR ) 4 - 6 ) for the oral part and 5 ( IQR 4 - 5.5 ) for the text part . CONCLUSION Medication review s performed and conveyed by a physician increased treatment with fracture-preventing drugs but did not significantly decrease treatment with fall-risk-increasing drugs in older adults with hip fracture . Prescribing physicians appreciated this intervention OBJECTIVE to assess whether  specialist osteoporosis nurses  delivering training to care home staff can reduce fractures and improve the prescription of treatments to reduce fractures versus usual care . DESIGN pragmatic cluster r and omised controlled trial ( RCT ) with r and omisation at the Primary Care Organisation ( PCO ) level . SETTING care homes ( residential , nursing and EMI ) across Engl and and Wales within PCOs . PARTICIPANTS all 300 PCOs in Engl and and Wales were invited to take part . Of these , 58 agreed to participate and gained ethical approval in time to start the study : 29 clusters were r and omised to the intervention group and 29 to the control . INTERVENTION specialist osteoporosis nurses undertaking short training sessions with care home staff emphase the importance of fracture and fall prevention and train staff on how to identify those residents at high risk of fracture . Residents ' risk of fracture and falls was reported to general practitioners ( GPs ) of patients along with treatment recommendations . OUTCOME MEASURES primary outcome measures were total fractures over the past 12 months and total hip fractures over past the 12 months . Secondary outcome measures were total home falls , number of residents sustaining a fall , number of residents prescribed bisphosphonates , number of residents prescribed calcium and vitamin D and number of residents wearing hip protectors . All outcomes were measured at the care home level . RESULTS of the 230 care homes r and omised data were collected from 209 of these containing 5,637 residents . There were no differences between the groups in the incidence rate ratios ( IRRs ) for total fractures ( IRR = 0.94 [ 0.71 , 1.26 ] P = 0.70 ) or total hip fractures ( IRR = 0.86 [ 0.63 , 1.18 ] P = 0.36 ) . No differences were found between groups for home falls or hip protector use . A significant increase in  bisphosphonate prescription was seen in the intervention group over the control group ( IRR = 1.50 [ 1.00 , 2.24 ] P = 0.05 ) .  Calcium and vitamin D prescription was significantly increased in the intervention group over the control group ( IRR = 1.64 [ 1.23 , 2.18 ] P<0.01 ) . CONCLUSION the intervention significantly increased the prescription of bisphosphonates and calcium/vitamin D , but was not associated with a significant effect on the rate of falls or fractures UNLABELLED We conducted a r and omized controlled trial within the setting of a large drug benefit plan for Medicare beneficiaries . Primary care physicians and their patients were r and omized to usual care , patient intervention only , physician intervention only , or both interventions . There was no difference in the probability of the primary composite endpoint ( BMD test or osteoporosis medication ) or in either of its components comparing the combined intervention group with usual care ( risk ratio = 1.04 ; 95 % CI , 0.85 - 1.26 ) . INTRODUCTION Fractures from osteoporosis are associated with substantial morbidity , mortality , and cost . However , only a minority of at-risk older adults receives screening and /or treatment for this condition . We evaluated the effect of educational interventions for osteoporosis targeting at-risk patients , primary care physicians , or both . MATERIAL S AND METHODS We conducted a r and omized controlled trial within the setting of a large drug benefit plan for Medicare beneficiaries . Primary care physicians and their patients were r and omized to usual care , patient intervention only , physician intervention only , or both interventions .  The at-risk patients were women > or=65 yr of age , men and women > or=65 yr of age with a prior fracture , and men and women > or=65 yr of age who used oral glucocorticoids .  The primary outcome studied was a composite of either undergoing a BMD test or initiating a medication used for osteoporosis . The secondary outcome was a hip , humerus , spine , or wrist fracture . RESULTS We r and omized 828 primary care physicians and their 13,455 eligible at-risk patients into four study arms . Physician and patient characteristics were very similar across all four groups . Across all four groups , the rate of the composite outcome was 10.3 per 100 person-years and did not differ between the usual care and the combined intervention groups ( p = 0.5 ) . In adjusted Cox proportional hazards models , there was no difference in the probability of the primary composite endpoint comparing the combined intervention group with usual care ( risk ratio = 1.04 ; 95 % CI , 0.85 - 1.26 ) . There was also no difference in either of the components of the composite endpoint . The probability of fracture during follow-up was 4.2 per 100 person-years and did not differ by treatment assignment ( p = 0.9 ) . CONCLUSIONS In this trial , a relatively brief program of patient and /or physician education did not work to improve the management of osteoporosis . More intensive efforts should be considered for future quality improvement programs for osteoporosis OBJECTIVES to evaluate the effectiveness of a policy of making hip protectors available to residents of nursing homes . DESIGN a cluster r and omised controlled trial of the policy in nursing and residential homes , with the home as the unit of r and omisation . SETTING 127 nursing and residential homes in the greater Belfast area of Northern Irel and . PARTICIPANTS 40 homes in the intervention group ( representing 1,366 occupied beds ) and 87 homes in the control group ( representing 2,751 occupied beds ) . INTERVENTIONS a policy of making hip protectors available free of charge to residents of nursing homes  and supporting the implementation process by employing a nurse facilitator to encourage staff in the homes to promote their use , over a 72-week period . MAIN OUTCOME MEASURES the rate of hip fractures in intervention and control homes , and the level of adherence to use of hip protectors . RESULTS there were 85 hip fractures in the intervention homes and 163 in the control homes . The mean fracture rate per 100 residents was 6.22 in the intervention homes and 5.92 in the control homes , giving an adjusted rate ratio for the intervention group compared to the control group of 1.05 ( 95 % CI 0.77 , 1.43 , P = 0.76 ) . Initial acceptance of the hip protectors was 37.2 % ( 508/1,366 ) with adherence falling to 19.9 % ( 272/1,366 ) at 72 weeks . CONCLUSIONS making hip protectors available to residents of nursing and residential homes did not reduce the rate of hip fracture . This research does not support the introduction of a policy of providing hip protectors to residents of nursing homes Background and aims : Given the high risk of subsequent fracture among elderly persons with fracture , it is important to initiate secondary treatment for osteoporosis . Acute rehabilitation centers may offer a unique opportunity to introduce treatment . Therefore , we evaluated willingness-to-participate and compliance with evidence -based interventions for the secondary prevention of  osteoporotic fracture in a non-r and omized study conducted in the acute rehabilitation setting . We also described differences in baseline characteristics between study participants and non- participants . Methods : All consecutive , community-dwelling admissions to an acute rehabilitation unit ( Boston , MA ) with the diagnosis of fracture were screened for enrollment . Eligible subjects were offered a free , 6-month supply of alendronate/cholecalciferol ( 70 mg/2800 IU weekly ) , calcium and vitamin D supplements , and fall prevention strategies . Six-month compliance ( ≥75 % consumption of medication or supplement ) with the interventions was determined at a home visit . Results : Among 62 eligible subjects , 25 agreed to participate . Non- participants were older than participants ( 86 vs 80 yrs , p<0.01 ) . There was no significant difference between other characteristics of participants and non- participants including sex , weight , type of fracture , cognitive status , and functional status . The most common reason for non-participation was reluctance to take another medication . Among participants , only 52 % were compliant with alendronate and 58 % were compliant with calcium and vitamin D supplementation at 6 months . Conclusions : Willingness-to-participate and compliance with secondary prevention strategies for osteoporosis was low in the acute rehabilitation setting , even when medications were provided free of cost . Educating individuals with fracture and their families on the consequences and treatment of osteoporosis may help to decrease the risk of sustaining a second fracture by accepting secondary preventive measures Osteoporotic medication after hip fracture is widely recommended by clinical practice guidelines , and medication adherence is essential to meet clinical trial risk reduction figures in the real world . We assessed primary and secondary non-adherence to osteoporosis medications  in patients discharged following a hip fracture and identified factors associated with secondary non-adherence . From a population -based retrospective cohort of 19,405 patients aged 65 years and over discharged from a hip fracture in the region of Valencia ( Spain ) from January 1 , 2008 and June 30 , 2012 , we followed , over a minimum of 365 days , 4,856 patients with at least one osteoporotic medication prescribed within the first six months after discharge . Less than one third of the patients discharged alive after a hip fracture received osteoporotic treatment .  Primary non-adherence among naïve patients was low . However , long-term secondary adherence measured by Proportion of Days Covered with medication ( PDC ) and persistence was largely suboptimal , with naïve users having worse results than experienced patients . Secondary non-adherence was associated with primary non-adherence and age , dementia or sedative treatments for naïve users and with being male , being older than 85 and having dementia for experienced users . Three quarters of naïve users and two thirds of experienced users had interrupted treatment at 48 months AIMS AND OBJECTIVES This study aim ed to evaluate the effectiveness of a comprehensive discharge-planning service for hip fracture patients , including length of stay , functional status , self-care knowledge and quality of life ( QOL ) . BACKGROUND Hip fractures are the most devastating result of osteoporosis . Care of these patients from the moment they enter the hospital until discharge and postdischarge is a challenging task , requiring a coordinated approach by an interdisciplinary team . DESIGN An experimental design was used . Methods . Fifty hip fracture patients were recruited from a medical centre in Taipei , Taiwan and r and omly divided into two groups . The control group received routine discharge nursing care and the experimental group received comprehensive discharge planning . After patient admission , research ers assessed discharge-planning needs , provided discharge nursing instruction , coordinated services and determined discharge placement based on assessment results . RESULTS ( i ) Mean age of 50 hip fracture patients was 78.75 ( SD 6.99 ) years .  Mean length of stay was 6.04 ( SD 2.41 ) days for the experimental group and 6.29 ( SD 2.17 ) for the control group . Difference between groups was not significant ( t = -0.394 , p = 0.696 ) . ( ii ) The self-care knowledge of the experimental group was higher than that of the control group ( F = 11.569 , p = 0.001 ) . ( iii ) Significant improvements were observed in functional status of both groups at three months postdischarge , with no significant differences observed between groups . However , the functional status of experimental group patients showed a slightly better trend than that of the control group . ( iv ) At three months postdischarge , QOL of experimental group patients was better than control group patients . CONCLUSIONS A comprehensive discharge-planning service can improve hip fracture patients '  self-care knowledge and QOL . RELEVANCE TO CLINICAL PRACTICE Results of this study can be used clinical ly as a basis for practical implementation of discharge-planning services in fracture patients Hip fracture has a significant economic and personal cost , involving hospital admission and functional impairment for elderly people . To assess the benefit of using a newly design ed hip protector ( new material and new design ) to prevent fracture in a realistic setting , a r and omised intervention-control design was used to trial the effectiveness of pads worn by high falls risk residents ( n=71 ) in nursing home for 9 months . 40 residents were in the intervention group and 31 were in the control group . A profile of falls , including time of day , and orientation was obtained to demonstrate the potential effectiveness of the protectors for injury prevention . Acceptance of the hip protector was also surveyed amongst nursing home staff and residents . One hundred and one falls and six fractures occurred in the control group . In contrast , one hundred and ninety one falls and three fractures occurred in the hip protector ( pads ) group . The three fractures in the protector wearing group occurred when pads were not in place . This was extrapolated as 1 in every 16.8 falls and 1 in every 63.7 falls result ing in fracture in the two groups , respectively . The relative risk of fracture was 0.264 ( 95 % CI=0.073 - 0.959 ) when the fracture incidence rate in the intervention group ( three fractures per 191 falls ) was compared to the control group ( six fractures per 101 falls ) . This is a statistically significant result and implies that this newly design ed hip protector is effective in preventing hip fracture . The majority of falls occurred during the day , which was when protectors were worn in this study , but the data on orientation was incomplete , with direction unknown in 74 % of falls . Compliance was an issue , which was interpreted as only 50.3 % of falls recorded with protectors in place . Dementia was identified as the explanation for this as the pads were often removed by these residents who comprised the majority of participants . Perception of low risk was the primary barrier to residents accepting the intervention . Comfort of protectors was not a significant concern for staff or residents , and only staff described appearance as an issue . In conclusion , the newly design ed hip protector is protective against fractures in a realistic setting . Compliance and acceptance of the protectors will ultimately determine the viability of this prophylaxis Summary The purpose of this study was to analyze the cost-effectiveness of a multifactorial fall prevention program in nursing home residents . Given a willingness-to-pay ( WTP ) of 50,000 EUR per year free of femoral fracture , the probability that the intervention is cost-effective is 83 % . Introduction Despite their increased risk of falls and fractures , nursing home residents have been neglected in economic evaluations of fall prevention programs so far . The purpose of this study was to analyze , for the first time , the cost-effectiveness of a multifactorial fall prevention program in nursing home residents . Methods This study is part of a prospect i ve , unblinded , cluster , nonr and omized , controlled study focusing on the transfer of an efficacious fall prevention program into a real-world setting . The analyzed sub sample was derived from cl aims data and consisted of data on intervention ( n = 256 , residents n = 10,178 ) and control homes ( n = 893 , residents n = 22,974 ) , representing all insurants of a sickness fund ( AOK Bavaria , Germany ) who were 65 years or older , residing in a nursing home on the 31st of March 2007 and had a level of care of ≥1 according to the classification of the statutory long-term care insurance . Time free of femoral fracture ( ICD-10 , S72 ) was used as measure of health effects . Femoral fracture-related costs and intervention costs were measured from a payer perspective . Multivariate regression models were applied . Sensitivity analyses were performed and cost-effectiveness acceptability curves computed . Results Within the first year of the intervention , femoral fracture rate was significantly reduced , result ing in a nonsignificant incremental mean time of 1.41 days free of femoral fracture . Incremental mean total direct costs were 29 EUR per resident , which was not significant . The incremental cost-effectiveness ratio ( ICER ) was 7,481 EUR per year free of femoral fracture . The probability of an ICER < 50,000 EUR per year free of femoral fracture was 83 % . Conclusion Depending on the amount the decision-maker is willing to pay for the incremental effect , the fall prevention program might be cost-effective within the first year . Future studies should exp and the range of costs and effects measured Summary Osteoporosis management post fragility fracture has traditionally been deficient with up to 60–90 % of patients remaining untreated for osteoporosis in some studies . Efforts have been made to address this deficiency with some successes reported . Introduction The aim of this study was to assess the efficacy of two different models of screening for osteoporosis in a community fracture clinic setting . Methods A prospect i ve r and omised clinical trial was conducted to assess the  DXA scan and treatment rates in patients with fragility fractures when assessment for osteoporosis had been initiated in the fracture clinic  compared with the “ usual care ” of assessment initiation by the participant ’s general practitioner . Results Sixty-six patients were enrolled in the study . Thirty-three patients each were in the control and intervention groups . The assessment rate ( DXA scan rate ) was significantly better in the intervention group where participants were referred for assessment from fracture clinic compared to the control group where participants were referred for assessment by their general practitioner ( 68 vs 36 % , respectively ; p < 0.05 ) . For patients who were assessed for osteoporosis , treatment rates were similar in both the control and intervention groups ( 100 vs 88 % , p > 0.05 ) . Conclusion This study demonstrates that screening for osteoporosis initiated in fracture clinic results in improved osteoporosis management compared to screening initiated in primary care . Orthopaedic surgeons and other specialists need to be more active in managing osteoporosis in patients who present with fragility fractures and should at the very least initiate assessment in the fracture clinic setting Approximately 12 % of postmenopausal women have osteoporotic vertebral fractures ( VFs ) ; these are associated with excess morbidity and mortality and a high risk of future osteoporotic fractures . Despite this , less than one-third come to clinical attention , partly due to lack of clear clinical triggers for referral for spinal radiographs . The aim of this study was to investigate whether a novel primary care – based screening tool could be used to identify postmenopausal women with osteoporotic VFs and increase appropriate management of osteoporosis . A r and omized controlled trial was undertaken in 15 general practice s within the Bristol area of the UK . A total of 3200 women aged 65 to 80 years were enrolled , with no exclusion criteria . A simple screening tool was carried out by a nurse in primary care to identify women at high risk of osteoporotic VFs . All identified high-risk women were offered a diagnostic thoracolumbar radiograph . Radiographs were reported using st and ard National Health Service ( NHS ) reporting , with results sent back to each participant 's general practitioner ( GP ) . Participants in the control arm did not receive the screening tool or radiographs . The main outcome measure was self-reported prescription of medication for osteoporosis at 6 months with a r and om 5 % sub sample verified against electronic GP records . Secondary outcome was self-reported incidence of new fractures . Results showed that allocation to screening increased prescription of osteoporosis medications by 124 % ( odds ratio [ OR ] for prescription 2.24 at 6 months ; 95 % confidence interval [ CI ] , 1.16 to 4.33 ) . Allocation to screening also reduced fracture incidence at 12-month follow-up ( OR for new fracture 0.60 ; 95 % CI , 0.35–1.03 ; p = 0.063 ) , although this did not reach statistical significance . This study supports the use of a simple screening tool administered in primary care to increase appropriate prescription of medications for osteoporosis in postmenopausal women in the UK . © 2012 American Society for Bone and Mineral Objective : To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis . Design : Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were r and omised to receive either a st and ard physician interview or an interview augmented by the presentation of 3-D bone models . Main outcome measures : Participants ’ beliefs about osteoporosis and bisphosphonate treatment , initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data . Results : Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview ( p = .04 ) and reported a greater underst and ing of osteoporosis at follow-up ( p = .04 ) , than the control group . While a greater proportion of the intervention group initiated an oral bisphosphonate regimen ( alendronate )  ( 52 % ) in comparison with the control group ( 21 % ) , the overall initiation of medication for osteoporosis , including  infusion ( zoledronate ) , did not differ significantly ( intervention group 62 % , control group 45 % , p = .19 ) . Conclusion : The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment In an attempt to identify a high-risk cohort of patients , who could be offered preventive therapy , we assessed patients who had suffered one hip fracture . A total of 394 patients were prospect ively followed to determine those who had suffered a second fracture . Entry bone mass of the unfractured hip and total body was examined by dual X-ray absorptiometry ( DXA ) and of the os calcis , by quantitative ultrasound ( QUS ) , along with various clinical parameters . The relative risks in the QUS parameters did not reach significance , except for broadb and ultrasound attentuation as measured by the McCue CUBA Clinical , whereas femoral neck and total body bone mineral density also reached significance . Lowest quartile body weight was also a significant risk factor as were occurrence of a new fall and poor mobility score . Using Receiver Operator Characteristic curves , we found no significant differences between DXA trochanter or for the Mini Mental State Examination score in predicting those who sustained a second hip fracture . In this elderly group risk factors are almost as good as bone mass at predicting those who will sustain a second hip fracture . Low body weight and poor mobility could be used as triggers for the use of preventive therapy without the use of bone mass measurements and to target expensive preventive therapy to reduce fracture risk
Applying different numerator and denominator combinations meant that the same observed number of patients could have result ed in different reported rates .
OBJECTIVE To examine the methods used to calculate the reported medication initiation rates in secondary fracture prevention programs .