WRISTWATCH: A PROSPECTIVE CONTROL TRIAL OF DISTAL RADIAL FRACTURES AS A MARKER FOR OSTEOPOROSIS INVESTIGATION.

Abstract

Osteoporosis investigation following a low-trauma fracture is often missed. The aim of this study was to (i) measure the current rate of osteoporosis investigation and (ii) to test a simple intervention that seeks to increase patient awareness and physician alerting following these sentinel events. Our study showed that 92% of the intervention group was investigated compared to 18% of the control group. This study suggests that a simple inexpensive intervention can increase the rate of osteoporosis investigation in an at risk population.

National guidelines (1–3) emphasize that low-trauma fractures should prompt to investigate for osteoporosis but more than 80% of “at risk” people are not investigated.

To measure the rate of diagnosis of osteoporosis when patients with low-trauma wrist fractures obtain usual care compared to a patient education and physician alerting intervention.

This is a prospective, controlled trial of patient education and physician alert following a distal radius fracture. Participants in the intervention group received four-parts: (i) an information sheet, (ii) a letter from the treating orthopedic surgeon to the patient’s family physician signaling the recent low-trauma fracture (iii) a follow-up reminder call to return to the family doctor for assessment and (iv) a fax to the family physician suggesting assessment and management of osteoporosis. The control group received usual care of the fracture and no specific information about osteoporosis. All participants were telephoned at 6 months to assess investigation status.

Fifty-one participants > 50 yrs. with a fragility wrist fracture were enrolled: 92% of the Intervention participants were investigated for osteoporosis by the family physician compared to 18% of the Control group. This is a significant difference (p ≤ 0.01).

This study suggests that a simple inexpensive intervention by the surgeon can increase the rate of osteoporosis investigation in an at risk population.

Orthopedic surgeons can contribute to the care of osteoporosis by readily adopting simple clinical actions which will make patients more likely to be investigated for osteoporosis.