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Hipwatch: osteoporosis investigation and treatment after a hip fracture : a 6-month randomized controlled trial Davis, Jennifer Colleen

Abstract

1) Objective: To test a novel Patient Empowerment and Physician Alerting (PEPA) intervention that seeks to improve the proportion of older adults who are diagnosed and treated for osteoporosis after hip fracture. 2) Methods: a) Design: Six-month randomized controlled trial. Participants were randomized either to the PEPA group (intervention) or the ’usual-care’ group (control). b) Participants and Setting: Forty-eight women and men aged 60 years and older who were admitted to Vancouver General Hospital for a fall-related hip fracture. c) Measurements: The Diagnosis and Management Questionnaire (DMQ) was administered to all participants to determine the initiation of investigation and treatment of osteoporosis. The responses were validated in part by physician report obtained for one fourth of the participants. d) Statistical Analyses: I compared the difference between the two experimental groups in the number of individuals who received one or more osteoporosis specific ’best practices’ within 6 months after their hip fracture using the chi-square test. The alpha level was set at p < 0.05. 3) Results: Of the 78 individuals who were eligible for this study, 48 agreed to participate. Among these participants, I found a significant difference between the intervention and the control group in the number of individuals who received one or more osteoporosis ’best practices’ after their hip fracture (p < 0.01). In the PEPA group, 54% (p < 0.01) were prescribed bisphosphonate therapy, 29% (p < 0.01) were investigated by a bone mineral density test, 39% were initiated on Calcium and Vitamin D (p = 0.32) and 32% (p < 0.01) were recommended exercise within 6 months after experiencing a fragility hip fracture. In contrast, in the usual-care group 0% were prescribed bisphosphonate therapy, 0% were investigated by a bone mineral density test, 30% were initiated on Calcium and Vitamin D and 0% were recommended exercise within 6 months after experiencing a fragility hip fracture. 4) Summary and Conclusions: This cohort of individuals who fractured their hip did not receive guideline care unless recommended by the PEPA intervention letters sent to the participant and delivered to the primary care physician. Patients who sustain a low-trauma hip fracture have osteoporosis but did not routinely receive recommended osteoporosis ’best practice’ care.

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