title: Key outcomes are usually not reported in published fracture secondary prevention programs: results of a systematic review.
abstract: OBJECTIVE
  A secondary analysis of a systematic review on interventions to improve osteoporosis (OP) investigation and treatment was conducted to examine reported key outcomes: (1) the cost of the intervention; (2) the proportion of patients taking OP medication beyond 6 months of the intervention; and (3) the proportion of patients who re-fractured.
  
  
  METHODS
  Fifty-seven articles reporting on 54 studies (64 interventions) from 11 countries were included. Intervention studies to improve OP management were eligible if they were conducted in an orthopedic setting and included primary data on ≥20 patients presenting with a hip fracture or any fragility fracture. To compare outcome data across all interventions regardless of study design, an equated proportion (EP) using a denominator based on the intention-to-treat principle was derived. Whether a cost analysis had been conducted, the EP of patients who were taking medication beyond 6 months of the intervention, and the EP of patients who re-fractured during the study period were documented.
  
  
  RESULTS
  Of the 54 studies, 2 reported a cost analysis and demonstrated that the interventions were at least cost-effective. The EP for medication use beyond 6 months of the intervention ranged from 17 to 56% for four studies. The EP for re-fracture ranged from 0 to 5% for four studies.
  
  
  CONCLUSIONS
  Most interventions did not report key outcomes. In addition, authors used varying time frames for re-fracture and medication use, making direct comparisons impossible. Authors should consider including intervention costs, medication use beyond 6 months of the intervention, and re-fracture data in future fracture secondary prevention programs.
authors.affiliation: Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, salej@smh.ca.
authors.forename: Joanna E M
authors.initials: JE
authors.lastname: Sale
authors.forename: Dorcas
authors.initials: D
authors.lastname: Beaton
authors.forename: Josh
authors.initials: J
authors.lastname: Posen
authors.forename: Victoria
authors.initials: V
authors.lastname: Elliot-Gibson
authors.forename: Earl
authors.initials: E
authors.lastname: Bogoch
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use* / Q000652:urine*; D003362:Cost-Benefit Analysis; D006801:Humans; D057194:Intention to Treat Analysis; D009985:Orthopedics; D058866:Osteoporotic Fractures / Q000191:economics / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011643:Publishing; D055502:Secondary Prevention
chemical_list: D050071:Bone Density Conservation Agents