title: Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients.
abstract: This study aims to determine osteoporosis (OP) investigation and treatment within post-fracture initiatives conducted in fracture clinics and other orthopedic environments. A systematic review was conducted. Eligibility criteria were: hip fracture patients plus all other fracture patients presenting with a fragility fracture, orthopedic setting where orthopedic physicians/staff were involved, intervention to improve OP management, primary data on ≥20 patients from randomized controlled trials (RCTs) and other study designs. We calculated outcome data within 6 months of screening from an intention-to-treat principle to derive an equated proportion (EP) across interventions. Outcomes were: (1) proportion of patients investigated with bone densitometry, (2) proportion of patients initiating OP medication, and (3) proportion of patients taking OP medication. We identified 2,259 citations, of which 57 articles that included 64 intervention groups were eligible. The median EP for patients investigated was 43% and the 75th percentile was 71%. The median EP for medication initiation was 22% and the 75th percentile was 34%. The median EP for medication taking was 27.5% and the 75th percentile was 43%. The EPs for all outcomes were higher for interventions with dedicated personnel to implement the intervention and those within which bone mineral density testing and/or treatment were included. In studies with an EP, up to 71% of patients were investigated for OP, but <35% initiated medication, and <45% were taking medication within 6 months of screening. Calculating an EP allowed us to compare outcomes across the studies, therefore capturing both RCTs and other study designs typical of real-world settings.
authors: Mobility Program Clinical Research Unit, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. salej@smh.ca
authors: J E M
authors: JE
authors: Sale
authors: D
authors: D
authors: Beaton
authors: J
authors: J
authors: Posen
authors: V
authors: V
authors: Elliot-Gibson
authors: E
authors: E
authors: Bogoch
references: Joint Bone Spine. 2005 Dec;72(6):562-6
references: 15996502
references: Osteoporos Int. 2002;13(6):450-5
references: 12107657
references: Ann Pharmacother. 2008 Mar;42(3):334-40
references: 18303134
references: J Bone Joint Surg Am. 2008 Nov;90(11):2346-53
references: 18978403
references: J Hand Surg Br. 2004 Oct;29(5):473-6
references: 15336753
references: Acta Orthop. 2006 Feb;77(1):3-8
references: 16534695
references: J Natl Med Assoc. 2009 Feb;101(2):145-50
references: 19378631
references: Ann R Coll Surg Engl. 2006 Sep;88(5):470-4
references: 17002853
references: J Bone Joint Surg Am. 2006 Jan;88(1):25-34
references: 16391246
references: Calcif Tissue Int. 2007 Aug;81(2):85-91
references: 17629737
references: CMAJ. 2001 Mar 20;164(6):777-81
references: 11276543
references: Ann Intern Med. 2006 Mar 21;144(6):427-37
references: 16549855
references: Osteoporos Int. 2007 Mar;18(3):261-70
references: 17086470
references: Arch Intern Med. 2007 Oct 22;167(19):2110-5
references: 17954806
references: Arthritis Rheum. 2007 Dec 15;57(8):1502-6
references: 18050169
references: Osteoporos Int. 2003 Dec;14(12):1028-34
references: 14600804
references: Osteoporos Int. 2006;17(3):410-6
references: 16283067
references: Prof Nurse. 2004 Jan;19(5):286-90
references: 14737805
references: J Am Geriatr Soc. 2006 Mar;54(3):450-7
references: 16551312
references: Osteoporos Int. 2004 Sep;15(9):695-700
references: 15007544
references: J Hand Ther. 2004 Jul-Sep;17(3):324-8
references: 15273672
references: Osteoporos Int. 2003 Jul;14(6):490-5
references: 12730761
references: Joint Bone Spine. 2007 Mar;74(2):160-5
references: 16987682
references: Osteoporos Int. 2001;12(5):337-42
references: 11444079
references: Arthritis Rheum. 2009 Feb 15;61(2):209-15
references: 19177538
references: J Clin Densitom. 2008 Oct-Dec;11(4):473-7
references: 18562228
references: Contemp Clin Trials. 2008 Mar;29(2):194-210
references: 17766187
references: Osteoporos Int. 2007 Dec;18(12):1633-9
references: 17603741
references: Jt Comm J Qual Patient Saf. 2005 May;31(5):267-74
references: 15960017
references: J Clin Rheumatol. 2007 Apr;13(2):70-2
references: 17414532
references: Osteoporos Int. 2006;17(9):1309-17
references: 16804739
references: Arthritis Rheum. 2005 Apr 15;53(2):198-204
references: 15818644
references: Osteoporos Int. 2004 May;15(5):405-10
references: 14676993
references: Bone. 2007 Jun;40(6):1643-9
references: 17433805
references: Intern Med J. 2007 Oct;37(10):717-20
references: 17894768
references: Osteoporos Int. 2003 Sep;14(9):757-60
references: 12897979
references: Arch Intern Med. 2009 Jan 12;169(1):25-31
references: 19139320
references: Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S33-8
references: 18204397
references: Endocr Pract. 2008 Jan-Feb;14(1):58-68
references: 18238742
references: Osteoporos Int. 2006;17(6):847-54
references: 16570119
references: CMAJ. 2008 Feb 26;178(5):569-75
references: 18299546
references: J Bone Joint Surg Am. 2002 Aug;84(8):1342-8
references: 12177263
references: J Bone Joint Surg Am. 2008 Jan;90(1):163-73
references: 18171971
references: Best Pract Res Clin Rheumatol. 2005 Dec;19(6):1081-94
references: 16301198
references: CMAJ. 2002 Nov 12;167(10 Suppl):S1-34
references: 12427685
references: Osteoporos Int. 2008 Dec;19(12):1733-40
references: 18629567
references: Med Care. 2007 Sep;45(9):902-6
references: 17712262
references: Intern Med J. 2004 Mar;34(3):129-32
references: 15030462
references: Osteoporos Int. 2005 Sep;16(9):1079-85
references: 15586267
references: Osteoporos Int. 2007 Aug;18(8):1127-36
references: 17333450
references: J Bone Joint Surg Am. 2005 Jan;87(1):3-7
references: 15634808
references: Injury. 2005 Sep;36(9):1080-4
references: 16051239
references: Osteoporos Int. 2003 Aug;14(8):665-71
references: 12879218
references: J Bone Joint Surg Am. 2008 Feb;90(2):241-8
references: 18245581
references: J Bone Joint Surg Am. 2006 Sep;88(9):1968-74
references: 16951113
references: J Eval Clin Pract. 2007 Oct;13(5):801-5
references: 17824875
references: Osteoporos Int. 2003 Apr;14(2):171-8
references: 12730739
references: Aust Fam Physician. 2002 Oct;31(10):921-8
references: 12404830
references: J Clin Densitom. 1999 Winter;2(4):363-70
references: 10677789
references: J Bone Joint Surg Am. 2010 Aug 18;92(10):1973-80
references: 20720140
references: Ann Intern Med. 2004 Sep 7;141(5):366-73
references: 15353428
references: J Bone Joint Surg Am. 2008 Nov;90 Suppl 4:188-94
references: 18984730
references: Arch Orthop Trauma Surg. 2009 Feb;129(2):245-50
references: 19125257
references: J Bone Joint Surg Am. 2008 May;90(5):953-61
references: 18451385
references: J Gerontol A Biol Sci Med Sci. 2007 Aug;62(8):888-91
references: 17702881
references: Calcif Tissue Int. 2000 Feb;66(2):113-8
references: 10652958
references: BMJ. 1999 Sep 11;319(7211):670-4
references: 10480822