Skip to main content

Advertisement

SpringerLink
Log in

Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

We conducted a multicenter, randomized controlled trial to evaluate the impact of a population-based patient-centered post-fracture care program with a dedicated case manager, PREVention of OSTeoporosis (PREVOST), on appropriate post-fracture osteoporosis management. We showed that, compared to usual care, BMD investigation post-fracture was significantly improved (+20%) by our intervention program.

Introduction

Our study aims to evaluate the impact of a population-based patient-centered post-fracture care program, PREVOST, on appropriate post-fracture care.

Methods

Multicenter, randomized controlled trial enrolling 436 women aged 50 to 85 years and attending a French hospital, for a low-energy fracture of the wrist or humerus. Randomization was stratified by age, hospital department, and site of fracture. The intervention was performed by a trained case manager who interacted only with the patients, with repeated oral and written information about fragility fractures and osteoporosis management, and prompting them to visit their primary care physicians. Control group received usual care. The primary outcome was the initiation of an appropriate post-fracture care defined by Bone Mineral Density (BMD) and/or anti-osteoporotic treatment prescription at 6 months.

Results

At 6 months, 53% of women in intervention group initiated a post-fracture care versus 33% for usual care (adjOR 2.35, 95%CI [1.58–3.50], p < 0.001). Post-fracture care was more frequent after wrist than humerus fracture (adjOR 1.93, 95%CI [1.14–3.30], p = 0.015) and decreased with age (adjOR for 10 years increase 0.76, 95%CI [0.61–0.96], p = 0.02). The intervention resulted in BMD prescription in 50% of patients (adjOR 2.10, 95%CI [1.41–3.11], p < 0.001) and in BMD performance in 41% of patients (adjOR 2.12, 95%CI [1.40–3.20], p < 0.001) versus 33 and 25% for usual care, respectively. Having performed a BMD increased treatment prescription; however, only 46% of women with a low BMD requiring a treatment according to the French guidelines received a prescription.

Conclusion

A patient-centered care program with a dedicated case manager can significantly improve post-fracture BMD investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Barrett-Connor E, Sajjan SG, Siris ES, Miller PD, Chen YT, Markson LE (2008) Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 19:607–613

    Article  CAS  PubMed  Google Scholar 

  2. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521

    Article  CAS  PubMed  Google Scholar 

  3. Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382

    Article  CAS  PubMed  Google Scholar 

  4. Briot K, Cortet B, Thomas T et al (2012) 2012 update of French guidelines for the pharmacological treatment of postmenopausal osteoporosis. Joint Bone Spine 79:304–313

    Article  PubMed  Google Scholar 

  5. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY (2012) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57

    Article  PubMed  PubMed Central  Google Scholar 

  6. Little EA, Eccles MP (2010) A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis. Implement Sci 5:80

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24:393–406

    Article  CAS  PubMed  Google Scholar 

  8. Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM (2012) A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving. Osteoporos Int 23:1623–1629

    Article  CAS  PubMed  Google Scholar 

  9. Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305

    Article  CAS  PubMed  Google Scholar 

  10. Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778

    Article  CAS  PubMed  Google Scholar 

  11. Sujic R, Gignac MA, Cockerill R, Beaton DE (2011) A review of patient-centred post-fracture interventions in the context of theories of health behaviour change. Osteoporos Int 22:2213–2224

    Article  CAS  PubMed  Google Scholar 

  12. Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C (2013) Capture the fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Crawford Shearer NB (2009) Health empowerment theory as a guide for practice. Geriatr Nurs 30:4–10

    Article  PubMed Central  Google Scholar 

  14. Wong CK, Wong WC, Lam CL, Wan YF, Wong WH, Chung KL, Dai D, Tsui EL, Fong DY Effects of Patient Empowerment Programme (PEP) on clinical outcomes and health service utilization in type 2 diabetes mellitus in primary care: an observational matched cohort study. PLoS One 9:e95328

  15. Curran D, Maravic M, Kiefer P, Tochon V, Fardellone P (2010) Epidemiology of osteoporosis-related fractures in France: a literature review. Joint Bone Spine 77:546–551

    Article  PubMed  Google Scholar 

  16. Cawston H, Maravic M, Fardellone P, Gauthier A, Kanis JA, Compston J, Borgstrom F, Cooper C, McCloskey E (2012) Epidemiological burden of postmenopausal osteoporosis in France from 2010 to 2020: estimations from a disease model. Arch Osteoporos 7:237–246

    Article  CAS  PubMed  Google Scholar 

  17. Maravic M, Le Bihan C, Landais P, Fardellone P (2005) Incidence and cost of osteoporotic fractures in France during 2001. A methodological approach by the national hospital database. Osteoporos Int 16:1475–1480

    Article  PubMed  Google Scholar 

  18. Sale JE, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2011) Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporos Int 22:2067–2082

    Article  CAS  PubMed  Google Scholar 

  19. Jaglal SB, Donescu OS, Bansod V et al (2012) Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial. Osteoporos Int 23:87–95

    Article  CAS  PubMed  Google Scholar 

  20. Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, McLellan AR, Mitchell PJ, Sale JE, Wahl DA (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22:2051–2065

    Article  CAS  PubMed  Google Scholar 

  21. Bell K, Strand H, Inder WJ (2014) Effect of a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma non-hip fracture: a systematic review. Arch Osteoporos 9:167

    Article  PubMed  Google Scholar 

  22. Majumdar SR, Johnson JA, Bellerose D et al (2011) Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study. Osteoporos Int 22:223–230

    Article  CAS  PubMed  Google Scholar 

  23. Dell R, Greene D (2010) Is osteoporosis disease management cost effective? Curr Osteoporos Rep 8:49–55

    Article  PubMed  Google Scholar 

  24. Majumdar SR, Lier DA, Beaupre LA, Hanley DA, Maksymowych WP, Juby AG, Bell NR, Morrish DW (2009) Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med 169:25–31

    Article  PubMed  Google Scholar 

  25. Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 88:25–34

    PubMed  Google Scholar 

  26. Queally JM, Kiernan C, Shaikh M, Rowan F, Bennett D (2013) Initiation of osteoporosis assessment in the fracture clinic results in improved osteoporosis management: a randomised controlled trial. Osteoporos Int 24:1089–1094

    Article  CAS  PubMed  Google Scholar 

  27. Leslie WD, LaBine L, Klassen P, Dreilich D, Caetano PA (2012) Closing the gap in postfracture care at the population level: a randomized controlled trial. CMAJ 184:290–296

    Article  PubMed  PubMed Central  Google Scholar 

  28. Majumdar SR, Johnson JA, McAlister FA, Bellerose D, Russell AS, Hanley DA, Morrish DW, Maksymowych WP, Rowe BH (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ 178:569–575

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sale JE, Beaton DE, Elliot-Gibson VI, Bogoch ER, Ingram J (2010) A postfracture initiative to improve osteoporosis management in a community hospital in Ontario. J Bone Joint Surg Am 92:1973–1980

    Article  PubMed  Google Scholar 

  30. Viprey M, Caillet P, Canat G, Jaglal S, Haesebaert J, Chapurlat R, Schott AM (2015) Low osteoporosis treatment initiation rate in women after distal forearm or proximal humerus fracture: a healthcare database nested cohort study. PLoS One 10:e0143842

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mitchell PJ (2013) Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep 11:52–60

    Article  PubMed  Google Scholar 

  32. Eisman JA, Bogoch ER, Dell R et al (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27:2039–2046

    Article  PubMed  Google Scholar 

  33. McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22:2083–2098

    Article  CAS  PubMed  Google Scholar 

  34. Aizer J, Bolster MB (2014) Fracture liaison services: promoting enhanced bone health care. Curr Rheumatol Rep 16:455

    Article  PubMed  Google Scholar 

  35. Dehamchia-Rehailia N, Ursu D, Henry-Desailly I, Fardellone P, Paccou J (2014) Secondary prevention of osteoporotic fractures: evaluation of the Amiens University Hospital’s fracture liaison service between January 2010 and December 2011. Osteoporos Int 25:2409–2416

    Article  CAS  PubMed  Google Scholar 

  36. Boudou L, Gerbay B, Chopin F, Ollagnier E, Collet P, Thomas T (2011) Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int 22:2099–2106

    Article  CAS  PubMed  Google Scholar 

  37. Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA, IOF EURPo (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8:137

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Axelsson KF, Jacobsson R, Lund D, Lorentzon M (2016) Effectiveness of a minimal resource fracture liaison service. Osteoporos Int 27:3165–3175

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Yong JH, Masucci L, Hoch JS, Sujic R, Beaton D (2016) Cost-effectiveness of a fracture liaison service—a real-world evaluation after 6 years of service provision. Osteoporos Int 27:231–240

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank D. Foesser for the great work she performed by contacting all women by telephone; the physicians, orthopedic surgeons, and staff of the emergency and orthopedics departments from the 20 hospitals involved in patients recruitment: Dr. X. Jacob, Centre Hospitalier Universitaire Lyon-Sud, HCl, 69310 Pierre-Bénite; Dr. F. Boissier, Centre Hospitalier Pierre Oudot, 38317 Bourgoin-Jallieu; Dr. R. Brunon, Centre Hospitalier, 42700 Firminy; Dr. Hage and Ms. C. Dumas, Centre Hospitalier, 69655 Villefranche sur Saône; Drs. V. Locquet, F. Breden, M. Ninou, P. Rostoucher, L. Erhard, K. Elkholti, M. Pozetto, Institut Chirurgical de la Main et du Membre supérieur, Clinique du Tonkin, 69100 Villeurbanne; Dr. H. Rouvière, Clinique Charcot, 69110 Ste.-Foy-les-Lyon; Dr. J.J. Azoulay, Clinique du Parc, 42276 Saint-Priest en Jarez; Dr. W. Tohoubi, Centre Hospitalier, 42300 Roanne; Dr. H. Kaddour, Centre Hospitalier Universitaire Grenoble Nord, 38043 Grenoble; Dr. A. Rakaa, Clinique mutualiste ‘Les Portes du Sud’, 69694 Vénissieux; Pr. G. Herzberg, Centre Hospitalier Universitaire Edouard Herriot, HCL, 69437 Lyon; Dr. P. Ganansia, Centre Hospitalier, 38506 Voiron; Dr. O. Carle, Centre Hospitalier, 07100 Annonay; Dr. M. Prost, Fondation Hotel-Dieu, 71206 le Creusot; Dr. S. Tabyaoui and Ms. P. Sultan, Centre Hospitalier, 71307 Montceau les Mines; Dr. J. Asdrubal, Centre Hospitalier, 71018 Mâcon; Dr. J. Henner, Centre Hospitalier, 73200 Albertville-Moutiers; Dr. J. Lopez, Centre Hospitalier Privé de la Loire 42100 St-Etienne; Drs. A. Alnachif, P.E. Koueke, Centre Hospitalier Emile Roux, 43012 Le Puy en Velay; Drs. A. Henniche, F. Champly, Centre Hospitalier, 74703 Sallanches; Dr. C. Dupraz from ‘the Collège Lyonnais des Généralistes Enseignants’.

Author information

Authors and Affiliations

  1. INSERM Unit 1033, Université de Lyon, Service de Rhumatologie, Hospices Civils de Lyon, Lyon, France

    B. Merle, R. Chapurlat & E. Vignot

  2. INSERM Unit 1033, Department of Rheumatology, Hôpital Edouard Herriot, Pavillon F, Place d’Arsonval, 69437, Lyon, France

    B. Merle

  3. Service de Rhumatologie, INSERM Unit 1059, Hôpital Bellevue, Saint-Etienne, France

    T. Thomas

  4. Hospices Civils de Lyon, EA 7425 HeSPeR Unit, Université de Lyon, Lyon, France

    J. Haesebaert & A.-M. Schott

Authors
  1. B. Merle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Chapurlat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Vignot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Haesebaert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A.-M. Schott
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Merle.

Ethics declarations

Funding

Grant from the French Ministry of Health: PREVOST, PREPS 2012- n°: 12-027-0088

Conflicts of interest

None.

Additional information

Trial Registration—clinicaltrials.gov Identifier n°: NCT01780012

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Merle, B., Chapurlat, R., Vignot, E. et al. Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial. Osteoporos Int 28, 1549–1558 (2017). https://doi.org/10.1007/s00198-017-3953-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-3953-z

Keywords

Search

Navigation