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A Postfracture Initiative to Improve Osteoporosis Management in a Community Hospital in Ontario
Joanna E.M. Sale, PhD1; Dorcas E. Beaton, PhD1; Victoria I.M. Elliot-Gibson, MSc1; Earl R. Bogoch, MD1; Jennifer Ingram, MD2
1 Mobility Program Clinical Research Unit, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. E-mail address for J.E.M. Sale: salej@smh.toronto.on.ca
2 Peterborough Regional Health Centre, 1 Hospital Drive, Peterborough, ON K9J 7C6, Canada
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Merck Frosst Canada. One or more of the authors, or a member of his or her immediate family, received payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Procter and Gamble Canada, Inc., and Merck Frosst Canada).

Investigation performed at Peterborough Regional Health Centre, Peterborough, Ontario, Canada

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Aug 18;92(10):1973-1980. doi: 10.2106/JBJS.I.00878
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Screening programs to manage osteoporosis in fracture clinic environments have had varying success in terms of increasing rates of investigation and initiation of treatment for the disease.


We determined rates of postfracture investigation and care for osteoporosis in patients screened through a coordinator-based initiative in a community hospital fracture clinic. A coordinator screened outpatients, educated them about osteoporosis, advised them to see their family physician for assessment and/or treatment, and performed follow-up at six months. Men who were fifty years of age or older and women who were forty years of age or older and had a fragility fracture were eligible.


Of 505 patients enrolled at baseline, 332 (66%) returned the follow-up questionnaire; 51% of those patients reported having had a bone mineral density test after screening and 26% had initiated first-line treatment (35% if the patients who had already initiated treatment at baseline were excluded) and an additional 23% were continuing treatment since baseline. After adjustment for demographic and baseline variables, patients who had initiated first-line treatment after screening were 4.15 times more likely to have had a bone mineral density test after screening than patients who had never initiated treatment and 11.67 times more likely to have had a bone mineral density test after screening than patients who had continued treatment since baseline.


A coordinator-based osteoporosis screening program was associated with osteoporosis investigation and treatment. A postfracture bone mineral density test was highly associated with treatment initiation.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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