Is it possible to improve routine detection and treatment of osteoporosis after an initial fracture?I) is it possible to increase the proportion of patients adequately screened and categorized as to the presence of osteoporosis from current practice…
ID
Source
Brief title
Condition
- Fractures
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
I) is it possible to increase the proportion of patients adequately screened
and categorized as to the presence of osteoporosis from current practice of
5-40% to at least 70%?
II) in patients found to have osteoporosis, is it possible to:
a) start treatment in nearly all applicable patients?
b) maintain the proportion of patients still on anti-osteoporotic treatment
after 1 year at 70% of those starting treatment?
Secondary outcome
III) are the data on subsequent fracture rates compatible with a reduction to
4%?
IV) is the proportion of patients screened for osteoporosis with a DXA
measurement significantly higher in the implementation group (with fracture
nurse) than in the control group (without a fracture nurse; 'usual care')?
V) is the proportion of patients still on anti-osteoporotic treatment after 1
year significantly higher in the implementation group than in the control group?
VI) what are the costs associated with the implementation of an osteoporosis
nurse and how do these costs compare to the health benefits obtained.
VII) what are the practical barriers encountered in trying to achieve the above
mentioned goals?
VIII) what are the practical barriers in the implementation of an osteoporosis
nurse, and how can these be overcome?
concerning population 2 and 3:
1. a) what proportion of patients without vertebral fractures and with a T
score of * -1 and >-2, has sustained a new clinical fracture one year after
the initial fracture?
b) what proportion of patients already being treated with
anti-osteoporotic medication, has sustained a new clinical fracture one year
after the initial fracture?
2. is the proportion of patients still on anti-osteoporotic treatment after 1
year significantly different in the implementation group than in the group of
patients who are being treated by another clinician or general practitioner?
Background summary
The aging population frequently incurs osteoporotic fractures that are
associated with high morbidity and increased mortality. Patients presenting
with their first fracture are at high risk for reccurence. Patients aged 50
years or older are often diagnosed with osteoporosis after a DXA measurement.
Effectieve and well tolerated drugs can reduce the incidence of new fractures
roughly by half. In current practive, only a small percentage of patients
presenting with a fracture above the age of 50 years are screened, and if
needed treated, for osteoporosis.
In a few hospitals in the Netherlands a nurse practitioner is appointed as a
central person, to screen and if needed treat, patients with fractures above
the age of 50.
Study objective
Is it possible to improve routine detection and treatment of osteoporosis after
an initial fracture?
I) is it possible to increase the proportion of patients adequately screened
and categorized as to the presence of osteoporosis from current practice of
5-40% to at least 70%?
II) in patients found to have osteoporosis, is it possible to:
a) start treatment in nearly all applicable patients?
b) maintain the proportion of patients still on anti osteoporotis treatment
after 1 year at 70% of those starting treatment?
Study design
4 hospitals participating in the implementationgroup: a nurse practioner
actively contacts patients above the age of 50 with a clinical fracture to
offer them screening (through DXA and risk factor analysis) and treatment of
osteoporosis. If the patient is diagnosed with osteoporosis, treatment will be
started, as well as advice on lifestyle and suppletion of vitamine D and
calcium. Every three months the patients will be contacted (through a telephone
call or a visit to the outpatient clinic) to assess, among other things,
compliance and new fractures.
4 hospitals participating in the control group: in these centers there is no
nurse prationer, but the usual care following a fracture. The patients will
receive information at home about the study and will be asked to participate.
Every three months they will receive questionairs.
Study burden and risks
In the control group there is no additional burden or risk; patients will
receive the usual care following a fracture.
In the implementation group most of the clinical investigations are normal
patient care (DXA measurement, blood samples) and offer no additional burden or
risk. A second DXA measurement after 12 months is optional and not considered
normal patient care, but its risk/burden is minimal. (comparable to an X ray)
Boelelaan 1117
1081 HV Amsterdam
NL
Boelelaan 1117
1081 HV Amsterdam
NL
Listed location countries
Age
Inclusion criteria
population 1:
-All patients 50 years of age or older, who have a clinical fracture and a low BMD defined as a T score * 2
population 2:
-All patients 50 years of age or older, who have a clinical fracture and a BMD defined as a T score of * -1 and >-2
population 3:
-All patients of 50 years or older, who have a clinical fracture and ar already being treated with anti-osteoporotic medication
Exclusion criteria
-patients with a fracture after a traffic accident
-patients with a pathological fracture
-patients with fractures of hand, foot or scull
-serious comorbidity or dementia
-incapable of visiting the out patient clinic
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL18087.029.07 |