Simple reminders may help prevent fractures

April 17, 2013

Reminding primary care doctors to test at-risk patients for osteoporosis can prevent fractures and reduce health care costs, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

Osteoporosis is a condition that is common, costly and undertreated. Low trauma in older individuals are a "red flag" for osteoporosis, but those at risk often are not treated for the condition. Rates of osteoporosis testing and treatment are typically less than 20 percent in the first year after a fracture.

"Sending family doctors and a reminder letter about evaluating fracture patients for osteoporosis significantly improved care at a very low cost," said William D. Leslie, MD, MSc, of the University of Manitoba in Canada, and senior author of this study. "The procedure more than paid for itself – in the long term it is projected to prevent fractures and save money."

The intervention involved two mail-based notices, one sent just to the physicians of more than 4,000 patients with recent fractures, and the other sent to both physicians and patients. The notices to physicians were personalized letters that included bone mineral density (BMD) testing guidelines and a flowchart of osteoporosis management. The second intervention combined the physician letter with a personalized letter to patients acknowledging their recent fracture and recommending they see their physician for an osteoporosis assessment.

These mail notices were inexpensive but effective. The notice to physicians cost just $7.12 (Canadian) per patient, and the note to physicians and patients cost $8.45. Within one year osteoporosis treatments increased by 1.5-fold (4 percent) as a result of the physician letter, and the physician-patient outreach increased treatment rates by 1.8-fold (6 percent) in the same time span. Economic simulations showed that for every 1,000 patients who received physician intervention, there were two fewer fractures, two more quality-adjusted years of life gained and $18,000 saved.

"Simple educational strategies targeting doctors and patients after a fracture have consistently failed to improve the quality of care," said Leslie. "The emergency doctors and orthopedic surgeons who treat fractures are not the ones responsible for preventing the next fracture – and the family physicians who deal with prevention aren't usually part of the team that treats the fracture. Connecting everyone involved – specialists, family and patients – systematically allowed for better care. A simple and very low-cost system using reminder letters can contribute to addressing this 'care gap' and is a strategy that would be easy for others to adopt."

Explore further: Physician notifications improve postfracture care for patients

More information: The article, "Cost-Effectiveness of Two Inexpensive Post-Fracture Osteoporosis Interventions: Results of a Randomized Trial," appears in the May 2013 issue of JCEM.

Related Stories

What do you know about that fracture?

April 21, 2011

A fracture in a person over the age of 50 can be a sign of osteoporosis, yet some patient populations have little knowledge of the disease. According to a groundbreaking study published in a recent Journal of Bone and Joint ...

Has osteoporosis treatment failed when a fracture occurs?

August 31, 2012

The International Osteoporosis Foundation (IOF) has published practical guidelines to assist clinicians in assessing treatment efficacy in patients who experience a fracture while on medication for osteoporosis.

Recommended for you

Zika virus infection alters human and viral RNA

October 20, 2016

Researchers at University of California San Diego School of Medicine have discovered that Zika virus infection leads to modifications of both viral and human genetic material. These modifications—chemical tags known as ...

Food-poisoning bacteria may be behind Crohn's disease

October 19, 2016

People who retain a particular bacterium in their gut after a bout of food poisoning may be at an increased risk of developing Crohn's disease later in life, according to a new study led by researchers at McMaster University.

Neurodevelopmental model of Zika may provide rapid answers

October 19, 2016

A newly published study from researchers working in collaboration with the Regenerative Bioscience Center at the University of Georgia demonstrates fetal death and brain damage in early chick embryos similar to microcephaly—a ...

Scientists uncover new facets of Zika-related birth defects

October 17, 2016

In a study that could one day help eliminate the tragic birth defects caused by Zika virus, scientists from the Florida campus of The Scripps Research Institute (TSRI) have elucidated how the virus attacks the brains of newborns, ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.