Closing the gap in postfracture care at the population level: a randomized controlled trial

Area of Science:

• Gerontology
• Public Health
• Clinical Medicine

Background:

• Postfracture care remains suboptimal, highlighting a critical need for improved management strategies.
• Osteoporosis treatment is often delayed or missed after major fractures in older adults.

Purpose of the Study:

• To evaluate the effectiveness of mailed notifications to physicians and patients in enhancing postfracture care.
• To assess improvements in bone mineral density (BMD) testing and osteoporosis pharmacologic treatment initiation.

Main Methods:

• A randomized controlled trial involving 4264 adults aged 50+ with major fractures was conducted in Manitoba, Canada.
• Participants were assigned to usual care, physician notification, or physician and patient notification groups.
• Outcomes, including BMD testing and osteoporosis treatment within 12 months, were tracked using medical claims data.

Main Results:

• Physician notification (groups 2 and 3) significantly increased BMD testing or osteoporosis treatment initiation compared to usual care (group 1).
• Rates improved from 15.8% in women and 7.6% in men (usual care) to over 30% in women and 19% in men in notification groups (p < 0.001).
• No additional benefit was observed from including patient notification.

Conclusions:

• A mailed notification system effectively enhances postfracture care by increasing osteoporosis diagnosis and treatment.
• This simple intervention demonstrates a significant impact on patient outcomes, with a number needed to notify of just 7.