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Orthopaedic Management Improves the Rate of Early Osteoporosis Treatment After Hip Fracture: A Randomized Clinical Trial

Miki, Roberto A. MD; Oetgen, Matthew E. MD; Kirk, Jessica MD; Insogna, Karl L. MD; Lindskog, Dieter M. MD

Journal of Bone & Joint Surgery - American Volume: 01 November 2008 - Volume 90 - Issue 11 - p 2346–2353
doi: 10.2106/JBJS.G.01246
Scientific Articles
Supplementary Content

Background: Although osteoporosis is strongly associated with hip fractures, the initiation of osteoporosis treatment following hip fractures occurs at surprisingly low rates of between 5% and 30%. Currently, most patients receiving treatment have been referred back to their primary care physician for osteoporosis management. The purpose of this study was to compare the effect of osteoporosis management initiated by the orthopaedic team and osteoporosis management initiated by the primary care physician on the rates of treatment at six months.

Methods: A prospective randomized trial was conducted to assess the difference in the rate of osteoporosis treatment when an in-house assessment of osteoporosis was initiated by the orthopaedic surgeon and follow-up was conducted in a specialized orthopaedic osteoporosis clinic compared with osteoporosis education and “usual” care.

Results: Sixty-two patients were enrolled in the study. Thirty-one patients each were in the control and intervention groups. The percentage of patients who were on pharmacologic treatment for osteoporosis at six months after the fracture was significantly greater when the evaluation was initiated by the orthopaedic surgeon and was managed in a specialized orthopaedic osteoporosis clinic (58%) than when treatment was managed by a primary care physician (29%) (p = 0.04).

Conclusions: An active role by orthopaedic surgeons in the management of osteoporosis improves the rate of treatment at six months following a hip fracture.

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

1Department of Orthopaedics, Miller School of Medicine, University of Miami, 900 N.W. 17th Street, Miami, FL 33136. E-mail address: rmiki2@med.miami.edu

2Department of Orthopaedic Surgery, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT 06510

3Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, P.O. Box 208020, New Haven, CT 06520-8020

Copyright 2008 by The Journal of Bone and Joint Surgery, Incorporated
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