Use of a case manager to improve osteoporosis treatment after hip fracture: results of a randomized controlled trial.
BACKGROUND
Patients who survive hip fracture are at high risk of recurrent fractures, but rates of osteoporosis treatment 1 year after sustaining a fracture are less than 10% to 20%. We have developed an osteoporosis case manager intervention. The case manager educated patients, arranged bone mineral density tests, provided prescriptions, and communicated with primary care physicians. The intervention was compared with usual care in a randomized controlled trial.


METHODS
We recruited from all hospitals that participate in the Capital Health system (Alberta, Canada), including patients 50 years or older who had sustained a hip fracture and excluding those who were receiving osteoporosis treatment or who lived in a long-term care facility. Primary outcome was bisphosphonate therapy 6 months after fracture; secondary outcomes included bone mineral density testing, appropriate care (bone mineral density testing and treatment if bone mass was low), and intervention costs.


RESULTS
We screened 2219 patients and allocated 220, as follows: 110 to the intervention group and 110 to the control group. Median age was 74 years, 60% were women, and 37% reported having had previous fractures. Six months after hip fracture, 56 patients in the intervention group (51%) were receiving bisphosphonate therapy compared with 24 patients in the control group (22%) (adjusted odds ratio, 4.7; 95% confidence interval, 2.4-8.9; P < .001). Bone mineral density tests were performed in 88 patients in the intervention group (80%) vs 32 patients in the control group (29%) (P < .001). Of the 120 patients who underwent bone mineral density testing, 25 (21%) had normal bone mass. Patients in the intervention group were more likely to receive appropriate care than were patients in the control group (67% vs 26%; P < .001). The average intervention cost was $50.00 per patient.


CONCLUSIONS
For a modest cost, a case manager was able to substantially increase rates of osteoporosis treatment in a vulnerable elderly population at high risk of future fractures.
Majumdar
Sumit R
SR
Department of Medicine, 362 Heritage Medical Research Center, University of Alberta, Edmonton AB T6G 2S2, Canada.
Beaupre
Lauren A
LA
Harley
Charles H
CH
Hanley
David A
DA
Lier
Douglas A
DA
Juby
Angela G
AG
Maksymowych
Walter P
WP
Cinats
John G
JG
Bell
Neil R
NR
Morrish
Donald W
DW
D000368:Aged; D000416:Alberta; D015519:Bone Density; D019090:Case Management; D005260:Female; D006620:Hip Fractures; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control*; D011787:Quality of Health Care; D016896:Treatment Outcome