Community based intervention to optimize osteoporosis management: randomized controlled trial

BMC Geriatrics

Research Article

Hui N Lee¹  Patricia M Ciaschini¹  Silvana Spadafora¹  Carol R Woods²  Luke A Fera³  Greg M Zimmerman⁴  Lisa R Dolovich⁵  Sumit R Majumdar⁶  Karen M Leung⁷  Sharon E Straus⁸  Ron A Goeree⁹ 

[1] Algoma District Medical Group, Sault Ste, Marie, Canada;Algoma Public Health, Sault Ste, Marie, Canada;Clinical Research Department, Group Health Centre, Sault Ste, Marie, Canada;Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada;Department of Biology, Lake Superior State University, Sault Ste, Marie, USA;Department of Family Medicine, McMaster University, Hamilton, Canada;Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Canada;Department of Medicine, University of Alberta, Edmonton, Canada;Department of Physical Therapy, Group Health Centre, Sault Ste, Marie, Canada;Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada;Department of Medicine, University of Toronto, Toronto, Canada;Program for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Hospital, Hamilton, Canada;Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada;

关键词: Bone Mineral Density;    Osteoporosis;    Usual Care;    Alendronate;    Raloxifene;   

DOI  :  10.1186/1471-2318-10-60

 received in 2010-02-23, accepted in 2010-08-27,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundOsteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis are underutilized. This pragmatic randomised study was done to evaluate the impact of a multifaceted community-based care program aimed at optimizing evidence-based management in patients at risk for osteoporosis and fractures.MethodsThis was a 12-month randomized trial performed in Ontario, Canada. Eligible patients were community-dwelling, aged ≥55 years, and identified to be at risk for osteoporosis-related fractures. Two hundred and one patients were allocated to the intervention group or to usual care. Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing, patient education and patient-specific recommendations for osteoporosis treatment. The primary outcome was the implementation of appropriate osteoporosis management.Results101 patients were allocated to intervention and 100 to control. Mean age of participants was 71.9 ± 7.2 years and 94% were women. Pharmacological treatment (alendronate, risedronate, or raloxifene) for osteoporosis was increased by 29% compared to usual care (56% [29/52] vs. 27% [16/60]; relative risk [RR] 2.09, 95% confidence interval [CI] 1.29 to 3.40). More individuals in the intervention group were taking calcium (54% [54/101] vs. 20% [20/100]; RR 2.67, 95% CI 1.74 to 4.12) and vitamin D (33% [33/101] vs. 20% [20/100]; RR 1.63, 95% CI 1.01 to 2.65).ConclusionsA multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care.Trial RegistrationThis trial has been registered with clinicaltrials.gov (ID: NCT00465387)

【 授权许可】

Unknown   
© Ciaschini et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.