Osteoporosis Treatment Improved by Simple Intervention

Older patients who visited local emergency rooms (ERs) for breathing difficulties or chest pain and underwent chest X-ray exams revealing unknown spinal fractures, were subsequently more likely to receive osteoporosis treatment if simple interventional methods were used.

Treatment rates for osteoporosis considerably improved when patients and their family physicians received follow-up information about the warning signs and risk factors of the condition. It is the first and only trial worldwide that examined spinal osteoporosis. Of those patients who were not targeted with the intervention, only 6% received follow-up treatment or testing for osteoporosis. When physicians were given educational material, the treatment or testing rate jumped to 49%. Furthermore, when both the physicians and patients were informed, the patients being treated or tested rate rose to 65%.

University of Alberta (Edmonton, AB, Canada) faculty of medicine and dentistry researcher Dr. Sumit Majumdar led the study published October 2012 in the American Journal of Medicine. It looked at patients over the age of 60 who visited two Edmonton emergency departments for various complaints and needed a chest X-ray, which incidentally revealed spinal fractures. One group of patients was not contacted for an intervention, only physicians were contacted in another group, and both physicians and their patients were contacted in a third group.

Family physicians targeted in the intervention received a one-page email, fax, or letter from local physicians and nurses that explained osteoporosis treatment guidelines and recommendations. The same nurse phoned some patients to share the same information and answered patients’ questions. These patients also received a pamphlet clarifying the association between spinal fractures and osteoporosis.

“The information we provided was not new. But the fact it was linked to a specific patient and had specific advice, it acted as a reminder about what actions family doctors could take when they next saw that patient,” said Dr. Majumdar. “These fractures identified in chest X-rays are associated with a 20-fold increase of future fractures in people with osteoporosis--and these can be devastating fractures like fractures of the hip that can lead to nursing home admission or death. What was also concerning is that two-thirds of the patients in the study had a previously documented wrist or hip fracture before the X-ray was done, but they never received osteoporosis treatment.”

Dr. Majumdar estimates the healthcare system could save USD 1,000 per patient, if high-risk patients similar to the ones in this study received proper follow-up testing and treatment for osteoporosis. Hip fractures alone cost about USD 50,000 each to treat, and osteoporosis costs the Canadian healthcare system about USD 1 billion a year.

When compared to the costs of the education intervention—USD 34 per physician and USD 42 per patient— “it’s the equivalent of one month’s supply of osteoporosis medication,” said Dr. Majumdar. One concerning revelation he noted in the study was that 25% of the patients were men and none of them received followed-up treatment or testing as part of routine care. Dr. Majumdar ascribed this to the fallacy that “osteoporosis is considered a disease of older women.”

Men have worse fractures and are more at risk to die of hip fractures than women, according to the investigators.

The research was funded by Knowledge Translation Canada, the Canadian Institutes of Health Research (CIH; Ottawa, Ontario, Canada) and Alberta Innovates-Health Solutions (Edmonton, Alberta, Canada). “This is both a research and a knowledge translation success story and CIHR would like to congratulate Dr. Majumdar on this important work,” said Phillip Gardiner of the CIHR Institute of Musculoskeletal Health and Arthritis. “The healthcare costs associated with osteoporosis can be reduced and treatments improved when creative approaches like this are developed and implemented.”

Dr. Majumdar reported that this educational intervention program could be a model for other disorders that could be diagnosed in the ER, with follow-up care being managed by nurses or pharmacists.

Related Links:
University of Alberta
Knowledge Translation Canada, the Canadian Institutes of Health Research