Community based intervention to optimize osteoporosis management: randomized controlled trial
1 Algoma District Medical Group, Sault Ste. Marie, Canada
2 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
3 Department of Medicine, University of Toronto, Toronto, Canada
4 Department of Family Medicine, McMaster University, Hamilton, Canada
5 Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Canada
6 Program for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Hospital, Hamilton, Canada
7 Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
8 Department of Physical Therapy, Group Health Centre, Sault Ste. Marie, Canada
9 Algoma Public Health, Sault Ste. Marie, Canada
10 Department of Biology, Lake Superior State University, Sault Ste. Marie, USA
11 Department of Medicine, University of Alberta, Edmonton, Canada
12 Clinical Research Department, Group Health Centre, Sault Ste. Marie, Canada
13 Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
BMC Geriatrics 2010, 10:60 doi:10.1186/1471-2318-10-60Published: 27 August 2010
Osteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis are underutilized. This pragmatic randomised study was done to evaluate the impact of a multifaceted community-based care program aimed at optimizing evidence-based management in patients at risk for osteoporosis and fractures.
This was a 12-month randomized trial performed in Ontario, Canada. Eligible patients were community-dwelling, aged ≥55 years, and identified to be at risk for osteoporosis-related fractures. Two hundred and one patients were allocated to the intervention group or to usual care. Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing, patient education and patient-specific recommendations for osteoporosis treatment. The primary outcome was the implementation of appropriate osteoporosis management.
101 patients were allocated to intervention and 100 to control. Mean age of participants was 71.9 ± 7.2 years and 94% were women. Pharmacological treatment (alendronate, risedronate, or raloxifene) for osteoporosis was increased by 29% compared to usual care (56% [29/52] vs. 27% [16/60]; relative risk [RR] 2.09, 95% confidence interval [CI] 1.29 to 3.40). More individuals in the intervention group were taking calcium (54% [54/101] vs. 20% [20/100]; RR 2.67, 95% CI 1.74 to 4.12) and vitamin D (33% [33/101] vs. 20% [20/100]; RR 1.63, 95% CI 1.01 to 2.65).
A multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care.
This trial has been registered with clinicaltrials.gov (ID: NCT00465387)