The Journal of Bone and Joint Surgery (American). 2005;87:3-7.
doi:10.2106/JBJS.D.02289
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Interventions to Improve Osteoporosis Treatment Following Hip Fracture

A Prospective, Randomized Trial

Michael J. Gardner, MD1, Robert H. Brophy, MD, MS1, Demetris Demetrakopoulos, BA1, Jason Koob, BA2, Richard Hong, BA3, Adam Rana, BA4, Julie T. Lin, MD1 and Joseph M. Lane, MD1

1 Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for M.J. Gardner: gardnerm{at}hss.edu
2 5050 South Lake Shore Drive, #3504, Chicago, IL 60615
3 c/o Joseph M. Lane, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
4 State University of New York Downstate, Box 154, 450 Clarkson Avenue, Brooklyn, NY 11203

Investigation performed at the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Merck, Eli Lily, and Proctor and Gamble. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Merck and Eli Lily) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Treatment of osteoporosis following a hip fracture has been notoriously poor. Many efforts have been made to improve treatment rates. The purpose of this study was to determine whether a perioperative inpatient intervention program, involving patient education and providing a list of questions for the primary care physician, increased the percentage of patients in whom osteoporosis was addressed following a hip fracture.

Methods: A prospective, randomized trial involving eighty patients who had been admitted to an academic medical center with a low-energy hip fracture was conducted. During their hospitalization, the study group patients were engaged in a fifteen-minute discussion regarding the association between osteoporosis and hip fractures, the efficacy of dual-energy x-ray absorptiometry scans in the diagnosis of osteoporosis and of bisphosphonates in its treatment, and the importance of medical follow-up for osteoporosis management. These patients were also provided with five questions regarding osteoporosis treatment to be given to their primary medical physician, and they were reminded about the questions during a follow-up telephone call six weeks later. The patients in the control group received a brochure describing methods for preventing falls. Both groups were contacted by telephone at six months after discharge to determine whether osteoporosis had been addressed. Positive indicators of intervention included assessment of bone mineral density with dual-energy x-ray absorptiometry and initiation of antiresorptive therapy.

Results: The average age in each group was eighty-two years, and 78% of the patients were female. Four patients in each group did not survive through the six-month follow-up period and were excluded from the trial. Fifteen (42%) of the thirty-six patients who had been randomized to the study group, compared with only seven (19%) of the thirty-six patients in the control group, had their osteoporosis addressed by their primary physician. This difference between the groups was significant (p = 0.036).

Conclusions: Patients who were provided with information and questions for their primary care physician about osteoporosis were more likely to receive appropriate therapeutic intervention than were patients who had not received the information and questions. Orthopaedic surgeons have a unique opportunity to improve the rate of osteoporosis treatment in the perioperative period following a hip fracture by educating patients and directing them toward channels for long-term osteoporosis management.

Level of Evidence: Therapeutic study, Level I. See Instructions to Authors for a complete description of levels of evidence.


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