title: A multifaceted intervention to improve treatment of osteoporosis in postmenopausal women with wrist fractures: a cluster randomized trial.
abstract: In a cluster randomized trial, we evaluated the effect of a multifaceted intervention (directed at both patient and primary care physician) on the rates of testing and treatment of osteoporosis in postmenopausal women within six months of their wrist fracture. Compared to usual care, women in the intervention practices were three times more likely to receive bone mineral density testing and prescribed osteoporosis treatments.
  
  
  BACKGROUND
  Postmenopausal women with wrist fractures are at increased risk of future fragility fractures, yet they frequently do not receive evaluation and treatment for osteoporosis. We set out to evaluate a multifaceted intervention designed to improve management of osteoporosis in older women with recent wrist fractures.
  
  
  METHODS
  Cluster randomized trial of 270 women cared for in 119 primary care practices. We recruited postmenopausal women with an acute wrist fracture from the emergency departments of hospitals in southeastern Ontario, Canada. Family practices were randomly assigned to either the intervention or usual care. The intervention consisted of a mailed reminder with a summary of treatment guidelines and letter sent to the primary care physician, in addition to an educational package and letter to the women. The primary outcome was the proportion of women prescribed osteoporosis therapy within 6 months of their fracture.
  
  
  RESULTS
  The mean age of women was 69(10.9) years. The intervention increased the proportion of women started on osteoporosis medications (28% vs. 10%) of controls, adjusted OR 3.45, 95% CI, 1.58-7.56, p = 0.002) and the proportion who had a bone mineral density (BMD) test (53.3% vs. 26%) of controls, OR 3.38, 95% CI, 1.83-6.26, p < 0.001). In addition to the intervention, having a female physician was a predictor of increased testing and treatment rates.
  
  
  CONCLUSIONS
  A multifaceted intervention significantly improved rates of osteoporosis treatment and BMD testing in postmenopausal women with wrist fractures.
authors.affiliation: Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada. ancranney@ohri.ca
authors.forename: A
authors.initials: A
authors.lastname: Cranney
authors.forename: M
authors.initials: M
authors.lastname: Lam
authors.forename: L
authors.initials: L
authors.lastname: Ruhland
authors.forename: R
authors.initials: R
authors.lastname: Brison
authors.forename: M
authors.initials: M
authors.lastname: Godwin
authors.forename: M M
authors.initials: MM
authors.lastname: Harrison
authors.forename: M B
authors.initials: MB
authors.lastname: Harrison
authors.forename: T
authors.initials: T
authors.lastname: Anastassiades
authors.forename: J M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: I D
authors.initials: ID
authors.lastname: Graham
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology*; D016000:Cluster Analysis; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011787:Quality of Health Care; D014954:Wrist Injuries / Q000453:epidemiology* / Q000517:prevention & control