SOS Alliance Research Spotlight- August 2018

As part of our work increasing awareness about fragility fractures in Australia and the importance of responding to them effectively, the SOS Alliance “Research Spotlight” will aim to highlight recent research publications that deal with fracture treatment and care. This month, two recent publications have caught our eye.

A new study lead by Dr Rishi Desai from Harvard Medical School in the US has found an alarming decline in treatment initiation rates in patients who have suffered a hip fracture. This decline happens despite overwhelming evidence that treatment of such patients reduces the chance of subsequent fractures and improves their long-term survival.

In the study the scientists reviewed the insurance claims of over 97,000 patients who were hospitalised for a hip fracture between 2004 and 2015. They found that over that time, the number of patients who commenced taking osteoporosis medication dropped from 9.8% to 3.3%.

This drop in treatment rate over the last decade was particularly concerning given the effect of treatment on subsequent fractures. Comparing patients who took treatment with those who didn’t, Dr Desai’s team found that treatment prevented 4.2 fractures for every 100 person-years.

Increasing the uptake of osteoporosis treatment in patients who suffer hip fractures could have significant improvements in both patient outcomes and public health benefits.

The full study, publicised in the JAMA Network Open, can be found here.

In a separate study, published recently in the Journal of Bone and Mineral Research, a team of researchers from the University of Alberta, Canada, compared different methods of post-fracture treatment recruitment.

They specifically compared two types of ‘Fracture Liaison Service’ (FLS) - a low intensity ‘active-control’ FLS that was patient driven, and a high intensity ‘case manager’ FLS that had dedicated nurse staff.

In the ‘active control’ FLS, a patient was contacted via phone call by a nurse 2-4 weeks after their fracture to discuss osteoporosis and its potential relevance to their fracture. They were then encouraged to follow up with their family physician to receive further care.

Conversely, in the ‘case manager’ FLS, a nurse would contact patients while they were still in the clinic with their initial fracture. They would discuss with the patient the association between fractures and osteoporosis. The nurse would then organise follow up testing and treatment to prevent further fractures in the patient.

The team found that the ‘case manager’ FLS was significantly more effective, resulting in 76% of patients receiving appropriate post-fracture care compared to only 44% of patients with ‘active-control’ FLS.

Moreover, the ‘case manager’ FLS was cheaper per minute of patient treatment time costing C$66 (Canadian dollars) for the average 51 minutes of treatment (C$1.29 per minute) compared to ‘active control’ C$18 for the average treatment of 11 minutes (C$1.63 per minute).

Thus, active post-fracture engagement and treatment will not only lead to better patient outcomes but may also be economically beneficial.

The full study can be found here.