Increasing the Detection and Treatment of Osteoporosis in Patients Who Present to an Emergency Department with a Wrist Fracture FREE

Osteoporosis is a condition in which bones become less dense and bone fractures occur more easily. Fractures can lead to substantial disability and costs. Two approaches help prevent osteoporosis-related fractures. One is to promote measures that can prevent osteoporosis itself, such as adequate calcium and vitamin D intake, physical activity, and avoidance of tobacco and alcohol. Some drugs, such as estrogen and bisphosphonates, can also prevent osteoporosis, but experts do not recommend these drugs for general use because of side effects and expense. The second approach is to test for osteoporosis in order to identify people with low bone density. These people are at highest risk for fracture and will benefit most from drugs that prevent fracture. Testing for osteoporosis involves using a special test called dual-energy x-ray absorptiometry(DEXA). Doctors should suspect osteoporosis in any adult patient who has a fracture without major trauma. Wrist fractures are common among people with osteoporosis, but many patients with wrist fracture do not get tested or treated for osteoporosis.

To evaluate a strategy to increase testing and treatment for osteoporosis in adults who present to an emergency department with wrist fracture.

102 patients who were 50 years of age and older and who were treated for wrist fracture in 2 emergency departments in Edmonton, Alberta, Canada. Patients were included in the study if they did not use treatments for osteoporosis and if their wrist fracture did not require hospitalization.

The researchers developed an intervention that included a fax to patients' primary care doctors in which the doctors were informed that one of their patients had been treated for a wrist fracture. The fax reminded doctors that fracture suggests that the patient might have osteoporosis and included a summary of osteoporosis recommendations. The researchers also developed a one-page information sheet about osteoporosis for patients and called patients within a week of the emergency department visit to review the information sheet. They encouraged patients to talk to their doctors about osteoporosis. The researchers used the intervention on alternate months in each of the two hospitals. While the intervention was “on” at one hospital, it was “off” at the other. They then compared the frequency of osteoporosis testing and treatment for patients who did and did not get the fax to their doctor, the information sheet, and the follow-up telephone call.

The frequency of testing and treatment for osteoporosis was about 3 times greater in patients who received the intervention than in those who did not.

The study did not examine whether increased testing and treatment led to fewer future fractures in patients who received the intervention.

Targeting patients who present to emergency departments with fractures seems to be a way to increase testing and treatment of osteoporosis.