Nav: Home

Post-fracture care: Do we need to educate patients rather than doctors?

April 25, 2017

Patients who suffer a first broken bone due to underlying osteoporosis are at two- to threefold risk of subsequent fractures -- which can lead to a host of serious outcomes such as pain, disability, loss of quality of life and even premature death. Given this danger, medical guidelines consistently recommend that fracture patients aged 50 or over, receive intervention that includes assessment of bone status and evaluation of fracture risk. However, despite clear medical recommendations, studies have shown that only approximately 20% of fracture patients are offered adequate post-fracture assessment and care.

Would it be more effective to empower the patients themselves to demand testing and care?

This question was asked by investigators from Lyon, France who set up a multicenter, randomized controlled trial (PREVOST) to evaluate the impact of a post-fracture care program with a dedicated case manager who interacts with the patients.

The trial enrolled 436 women, aged 50-85 years, who had attended hospital for treatment of a fragility fracture of the wrist or upper arm. While the control group received the usual care offered by the hospital or clinic, the intervention group also received repeated oral and written information about fragility fractures and osteoporosis management by a case manager. The case manager prompted the patients to visit their primary care physicians to ask for BMD testing and management.

Within six months, 53% of the women in the intervention group initiated post-fracture care versus 33% in the control group. The intervention resulted in BMD prescription for 50% of the women, with 41% following through with testing, versus 33% and 25% respectively for the control group. There was only a slight improvement in treatment prescription (13% in the intervention group versus 9%). Only 46% of the women with a low BMD for which treatment would be advised according to French guidelines, actually received treatment prescription -- reflecting the care gap in secondary prevention of osteoporosis that exists in France and worldwide.

Lead author Dr Blandine Merle of the Rheumatology Service, University of Lyon, stated: "In France as elsewhere, osteoporosis is underdiagnosed and undertreated -- including in high-risk fracture patients. Our randomized trial demonstrates that directly informing and involving patients in their post-fracture care follow-up, through the intervention of a case manager, can substantially improve the rate of BMD assessment. This type of intervention is easy to set up, relatively inexpensive, and may reach a large number of patients. Although more needs to be done to increase treatment rates and close the care gap, empowering patients to ask for BMD testing is an important first step. "
-end-
Reference

Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial. Merle, B., Chapurlat, R., Vignot, E., Thomas, T., Haesebaert, J., Schott, AM., Osteoporos Int (2017) 28: 1549. doi:10.1007/s00198-017-3953-z https://link.springer.com/article/10.1007/s00198-017-3953-z

http://rdcu.be/rrU1

International Osteoporosis Foundation

Related Osteoporosis Articles:

New pharmaceutical target reverses osteoporosis in mice
Biomedical engineers at Duke University have discovered that an adenosine receptor called A2B can be pharmaceutically activated to reverse bone degradation caused by osteoporosis in mouse models of the disease.
A link between mitochondrial damage and osteoporosis
In healthy people, a tightly controlled process balances out the activity of osteoblasts, which build bone, and osteoclasts, which break it down.
Many stroke patients not screened for osteoporosis, despite known risks
Many stroke survivors have an increased risk of osteoporosis, falls or breaks when compared to healthy people.
Many postmenopausal women do not receive treatment for osteoporosis
The benefits of treating osteoporosis in postmenopausal women outweigh the perceived risks, according to a Clinical Practice Guideline issued today by the Endocrine Society.
A new 'atlas' of genetic influences on osteoporosis
A ground-breaking new study led by researchers from the Lady Davis Institute (LDI) at the Jewish General Hospital (JGH) has succeeded in compiling an atlas of genetic factors associated with estimated bone mineral density (BMD), one of the most clinically relevant factors in diagnosing osteoporosis.
New recommendations for the conduct of economic evaluations in osteoporosis
An expert working group has established recommendations for the design and conduct of economic evaluations in osteoporosis, as well as guidance for reporting these evaluations.
From receptor structure to new osteoporosis drugs
Researchers at the University of Zurich have determined the three-dimensional structure of a receptor that controls the release of calcium from bones.
How a Mediterranean diet could reduce osteoporosis
Eating a Mediterranean-type diet could reduce bone loss in people with osteoporosis -- according to new research from the University of East Anglia.
Osteoporosis drug may benefit heart health
The osteoporosis drug alendronate was linked with a reduced risk of cardiovascular death, heart attack, and stroke in a Journal of Bone and Mineral Research study of patients with hip fractures.
New treatment for osteoporosis provides better protection against fractures
A new treatment for osteoporosis provides major improvements in bone density and more effective protection against fractures than the current standard treatment.
More Osteoporosis News and Osteoporosis Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.