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Research

Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial

Sumit R. Majumdar, Jeffrey A. Johnson, Finlay A. McAlister, Debbie Bellerose, Anthony S. Russell, David A. Hanley, Don W. Morrish, Walter P. Maksymowych and Brian H. Rowe
CMAJ February 26, 2008 178 (5) 569-575; DOI: https://doi.org/10.1503/cmaj.070981
Sumit R. Majumdar MD MPH
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Jeffrey A. Johnson PhD
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Finlay A. McAlister MD MSc
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Debbie Bellerose BScN
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Anthony S. Russell MD
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David A. Hanley MD
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Don W. Morrish MD PhD
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Walter P. Maksymowych MD
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Brian H. Rowe MD MSc
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Data supplements

  • Résumé

    Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial

    Sumit R. Majumdar MD MPH, Jeffrey A. Johnson PhD, Finlay A. McAlister MD MSc, Debbie Bellerose BScN, Anthony S. Russell MD, David A. Hanley MD, Don W. Morrish MD PhD, Walter P. Maksymowych MD, Brian H. Rowe MD MSc

    Departments of Medicine (Majumdar, McAlister, Bellerose, Russell, Morrish, Maksymowych) and Emergency Medicine (Bellerose, Rowe) and the School of Public Health (Johnson), University of Alberta, Edmonton, Alta.; and the Department of Medicine (Hanley), University of Calgary, Calgary, Alta.

    Correspondance : Dr Sumit R. Majumdar, Associate Professor, Department of Medicine, University of Alberta, 2E3.07 Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440–112th St., Edmonton AB  T6G 2B7; fax 780 407-2680; me2.majumdar{at}ualberta.ca

    Contexte : Les patients âgés qui subissent une fracture de fragilité présentent un risque élevé de fractures subséquentes, mais ils reçoivent rarement un test de dépistage ou un traitement de l’ostéoporose traitement. Nous avons mis au point une intervention à éléments multiples qui s’adresse aux patients âgés victimes de fractures du poignet (sous forme d’éducation par téléphone) et à leurs médecins (sous forme de lignes directrices approuvées par des meneurs d’opinion, appuyées par des rappels) afin d’améliorer la qualité du soin de l’ostéoporose.

    Méthodes : Au cours d’une étude contrôlée randomisée dont les résultats ont été déterminés à l’insu, nous avons comparé notre intervention aux soins habituels (remettre aux patients des documents d’éducation). Les patients admissibles avaient plus de 50 ans, avaient subi une fracture du poignet et avaient été vus à l'urgence ou dans une clinique de traitement des fractures. Nous avons exclu les patients déjà traités pour ostéoporose. Le principal résultat a été l'amorce d'un traitement aux bisphosphonates dans les six mois suivant la fracture. Les résultats secondaires ont inclus la mesure de la teneur minérale osseuse, les «soins appropriés» (mesure de la teneur minérale osseuse et traitement si la masse osseuse était faible) et la qualité de vie.

    Résultats : Nous avons examiné 795 patients pour déterminer leur admissibilité et nous en avons affecté au hasard 272 au groupe d’intervention (137 patients) ou au groupe témoin (135 patients). Leur âge médian s’établissait à 60 ans; 210 (77 %) des sujets étaient des femmes et 130 (48 %) avaient déclaré avoir déjà subi une fracture à l’âge adulte. Six mois après la fracture, 30 (22 %) des patients visés par l’intervention, comparativement à 10 (7 %) des patients témoins suivaient un traitement aux bisphosphonates pour ostéoporose (risque relatif RR rajusté, 2,6; intervalle de confiance IC à 95 %, 1,3–5,1; p = 0,008). Les patients visés par l’intervention étaient plus susceptibles que les patients témoins de recevoir un test de mesure de la teneur minérale osseuse (71/137 52 % c. 24/135 18 %; RR rajusté, 2,8; IC à 95 %, 1,9‑4,2; p < 0,001) et de recevoir les soins appropriés (52/137 38 % c. 15/135 11 %; RR rajusté, 3,1; IC à 95 %, 1,8–5,3; p < 0,001). Il n’y avait pas de différence entre les groupes pour les autres résultats. Un patient est décédé et quatre autres ont subi une autre fracture.

    Interprétation : Une intervention à multiples éléments visant les patients à risque élevé et leurs médecins a augmenté considérablement les taux d’examen et le traitement de l’ostéoporose. Plus de la moitié des patients du groupe visé par l’intervention ne recevaient néanmoins pas les soins appropriés six mois après avoir subi la fracture, ce qui indique qu’il faut explorer d’autres stratégies. (Registre gouvernemental des essais cliniques NCT00152321.)

  • Online Appendices

    Files in this Data Supplement:

    • Appendix 1: Example of treatment guidelines endorsed by opinion leaders
    • Appendix 2: Printed material provided to study participants in the intervention arm

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Canadian Medical Association Journal: 178 (5)
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Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial
Sumit R. Majumdar, Jeffrey A. Johnson, Finlay A. McAlister, Debbie Bellerose, Anthony S. Russell, David A. Hanley, Don W. Morrish, Walter P. Maksymowych, Brian H. Rowe
CMAJ Feb 2008, 178 (5) 569-575; DOI: 10.1503/cmaj.070981

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Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial
Sumit R. Majumdar, Jeffrey A. Johnson, Finlay A. McAlister, Debbie Bellerose, Anthony S. Russell, David A. Hanley, Don W. Morrish, Walter P. Maksymowych, Brian H. Rowe
CMAJ Feb 2008, 178 (5) 569-575; DOI: 10.1503/cmaj.070981
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