Comparing Strategies Targeting Osteoporosis to Prevent Fractures After an Upper Extremity Fracture (C-STOP Trial): A...

Area of Science:

• Orthopedics
• Geriatrics
• Public Health

Background:

• Osteoporosis management after fragility fractures is crucial for preventing subsequent events.
• Fracture Liaison Services (FLS) aim to improve osteoporosis care coordination.
• Comparative effectiveness of different FLS intensities requires further investigation.

Purpose of the Study:

• To compare the effectiveness of a high-intensity FLS (case manager) versus a low-intensity FLS (active-control) in managing osteoporosis after upper extremity fragility fractures.
• To evaluate differences in bisphosphonate treatment initiation, bone mineral density (BMD) testing, and appropriate care rates.

Main Methods:

• A pragmatic patient-level parallel-arm comparative effectiveness trial.
• 361 participants aged 50+ with upper extremity fractures, not on bisphosphonates, were randomized.
• Outcomes assessed at 6 months included bisphosphonate treatment, BMD testing, and a composite 'appropriate care' measure.

Main Results:

• High-intensity FLS (case manager) resulted in significantly higher bisphosphonate treatment rates (48% vs. 28%) and appropriate care (76% vs. 44%) compared to low-intensity FLS.
• BMD testing rates were also higher in the case manager group (73% vs. 62%).
• The case manager intervention had a higher direct cost per participant ($66 vs. $18 CDN).

Conclusions:

• Case-management FLS models lead to substantially greater improvements in osteoporosis treatment and appropriate care within 6 months post-fracture.
• High-intensity FLS is more effective in improving bone health management following fragility fractures.
• The findings support the implementation of intensified FLS programs for better patient outcomes.