title: Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial.
abstract: We conducted a multicenter, randomized controlled trial to evaluate the impact of a population-based patient-centered post-fracture care program with a dedicated case manager, PREVention of OSTeoporosis (PREVOST), on appropriate post-fracture osteoporosis management. We showed that, compared to usual care, BMD investigation post-fracture was significantly improved (+20%) by our intervention program.
  
  
  
  Our study aims to evaluate the impact of a population-based patient-centered post-fracture care program, PREVOST, on appropriate post-fracture care.
  
  
  
  Multicenter, randomized controlled trial enrolling 436 women aged 50 to 85 years and attending a French hospital, for a low-energy fracture of the wrist or humerus. Randomization was stratified by age, hospital department, and site of fracture. The intervention was performed by a trained case manager who interacted only with the patients, with repeated oral and written information about fragility fractures and osteoporosis management, and prompting them to visit their primary care physicians. Control group received usual care. The primary outcome was the initiation of an appropriate post-fracture care defined by Bone Mineral Density (BMD) and/or anti-osteoporotic treatment prescription at 6 months.
  
  
  
  At 6 months, 53% of women in intervention group initiated a post-fracture care versus 33% for usual care (adjOR 2.35, 95%CI [1.58-3.50], p < 0.001). Post-fracture care was more frequent after wrist than humerus fracture (adjOR 1.93, 95%CI [1.14-3.30], p = 0.015) and decreased with age (adjOR for 10 years increase 0.76, 95%CI [0.61-0.96], p = 0.02). The intervention resulted in BMD prescription in 50% of patients (adjOR 2.10, 95%CI [1.41-3.11], p < 0.001) and in BMD performance in 41% of patients (adjOR 2.12, 95%CI [1.40-3.20], p < 0.001) versus 33 and 25% for usual care, respectively. Having performed a BMD increased treatment prescription; however, only 46% of women with a low BMD requiring a treatment according to the French guidelines received a prescription.
  
  
  
  A patient-centered care program with a dedicated case manager can significantly improve post-fracture BMD investigation.
authors.affiliation: INSERM Unit 1033, Université de Lyon, Service de Rhumatologie, Hospices Civils de Lyon, Lyon, France. blandine.merle@inserm.fr.|INSERM Unit 1033, Department of Rheumatology, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France. blandine.merle@inserm.fr.
authors.forename: B
authors.initials: B
authors.lastname: Merle
authors.affiliation: INSERM Unit 1033, Université de Lyon, Service de Rhumatologie, Hospices Civils de Lyon, Lyon, France.
authors.forename: R
authors.initials: R
authors.lastname: Chapurlat
authors.affiliation: INSERM Unit 1033, Université de Lyon, Service de Rhumatologie, Hospices Civils de Lyon, Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Vignot
authors.affiliation: Service de Rhumatologie, INSERM Unit 1059, Hôpital Bellevue, Saint-Etienne, France.
authors.forename: T
authors.initials: T
authors.lastname: Thomas
authors.affiliation: Hospices Civils de Lyon, EA 7425 HeSPeR Unit, Université de Lyon, Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Haesebaert
authors.affiliation: Hospices Civils de Lyon, EA 7425 HeSPeR Unit, Université de Lyon, Lyon, France.
authors.forename: A-M
authors.initials: AM
authors.lastname: Schott
mesh_terms: D000368:Aged; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005602:France; D019983:Guideline Adherence; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D010353:Patient Education as Topic / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000209:etiology / Q000503:physiopathology
chemical_list: D050071:Bone Density Conservation Agents
keywords: Osteoporosis; Osteoporotic fractures; Patient empowerment; Randomized controlled trial; Secondary prevention