title: Interventions to increase osteoporosis treatment in patients with 'incidentally' detected vertebral fractures.
abstract: BACKGROUND
  Most vertebral compression fractures are not recognized or treated. We conducted a controlled trial in older patients with vertebral fractures incidentally reported on chest radiographs, comparing usual care with osteoporosis interventions directed at physicians (opinion-leader-endorsed evidence summaries and reminders) or physicians+patients (adding activation with leaflets and telephone counseling).
  
  
  METHODS
  Patients aged >60 years who were discharged home from emergency departments and who had vertebral fractures reported but were not treated for osteoporosis were allocated to usual care (control) or physician intervention using alternate-week time series. After 3 months, untreated controls were re-allocated to physician+patient intervention. Allocation was concealed, outcomes ascertainment blinded, and analyses intent-to-treat. Primary outcome was starting osteoporosis treatment within 3 months.
  
  
  RESULTS
  There were 1315 consecutive patients screened, and 240 allocated to control (n=123) or physician intervention (n=117). Groups were similar at baseline (average age 74 years, 45% female, 58% previous fractures). Compared with controls, physician interventions significantly (all P <.001) increased osteoporosis treatment (20 [17%] vs 2 [2%]), bone mineral density testing (51 [44%] vs 5 [4%]), and bone mineral density testing or treatment (57 [49%] vs 7 [6%]). Three months after controls were re-allocated to physician+patient interventions, 22% had started treatment and 65% had bone mineral density testing or treatment (P <.001 vs controls). Physician+patient interventions increased bone mineral density testing or treatment an additional 16% compared with physician interventions (P=.01).
  
  
  CONCLUSIONS
  An opinion-leader-based intervention targeting physicians substantially improved rates of bone mineral density testing and osteoporosis treatment in patients with incidental vertebral fractures, compared with usual care. Even better osteoporosis management was achieved by adding patient activation to physician interventions [NCT00388908].
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Canada. majumdar@ualberta.ca
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Debbie
authors.initials: D
authors.lastname: Bellerose
authors.forename: Kerry
authors.initials: K
authors.lastname: Siminoski
authors.forename: David A
authors.initials: DA
authors.lastname: Hanley
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Qazi
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Lier
authors.forename: Robert G
authors.initials: RG
authors.lastname: Lambert
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Russell
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002170:Canada; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D058996:Quality Improvement; D011859:Radiography; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome