Interventions to Increase Osteoporosis Treatment in Patients with ‘Incidentally’ Detected Vertebral Fractures

Sumit R. Majumdar, MD, MPH'Correspondence information about the author MD, MPH Sumit R. MajumdarEmail the author MD, MPH Sumit R. Majumdar, Finlay A. McAlister, MD, MSc, Jeffrey A. Johnson, PhD, Debbie Bellerose, BScN, Kerry Siminoski, MD, David A. Hanley, MD, Ibrahim Qazi, PhD, Douglas A. Lier, MA, Robert G. Lambert, MD, Anthony S. Russell, MD, Brian H. Rowe, MD, MSc
Interventions to Increase Osteoporosis Treatment in Patients with ‘Incidentally’ Detected Vertebral Fractures
American Journal of Medicine　September 2012Volume 125, Issue 9, Pages 929-936
DOI: https://doi.org/10.1016/j.amjmed.2012.02.021

Abstract
Background
Most vertebral compression fractures are not recognized or treated. We conducted a controlled trial in older patients with vertebral fractures incidentally reported on chest radiographs, comparing usual care with osteoporosis interventions directed at physicians (opinion-leader-endorsed evidence summaries and reminders) or physicians+patients (adding activation with leaflets and telephone counseling).
Methods
Patients aged >60 years who were discharged home from emergency departments and who had vertebral fractures reported but were not treated for osteoporosis were allocated to usual care (control) or physician intervention using alternate-week time series. After 3 months, untreated controls were re-allocated to physician+patient intervention. Allocation was concealed, outcomes ascertainment blinded, and analyses intent-to-treat. Primary outcome was starting osteoporosis treatment within 3 months.
Results
There were 1315 consecutive patients screened, and 240 allocated to control (n=123) or physician intervention (n=117). Groups were similar at baseline (average age 74 years, 45% female, 58% previous fractures). Compared with controls, physician interventions significantly (all P <.001) increased osteoporosis treatment (20 [17%] vs 2 [2%]), bone mineral density testing (51 [44%] vs 5 [4%]), and bone mineral density testing or treatment (57 [49%] vs 7 [6%]). Three months after controls were re-allocated to physician+patient interventions, 22% had started treatment and 65% had bone mineral density testing or treatment (P <.001 vs controls). Physician+patient interventions increased bone mineral density testing or treatment an additional 16% compared with physician interventions (P=.01).
Conclusions
An opinion-leader-based intervention targeting physicians substantially improved rates of bone mineral density testing and osteoporosis treatment in patients with incidental vertebral fractures, compared with usual care. Even better osteoporosis management was achieved by adding patient activation to physician interventions [NCT00388908].

関連する他の研究では、次のように結論している。

年配者の未診断の骨粗しょう症は胸部レントゲンの椎骨のひびに着目すると偶発的に検出できるかもしれない。
この研究では、椎骨のひびに着目して胸部レントゲンを再確認したところ、骨粗しょう症と関連があった骨所見が多数のケースで確認できたが、多くのケースがで診断されず、 3分の1が治療されなかったことが分かった。
459 人の患者の 72 人に脊椎のひびがあった。 43のひびはレントゲン写真のレポートで文書化されていた。  72 人の患者の 18の ひびだけが骨粗しょう症の既往があった。これらのひびの 43 だけが報告され、ひびの患者の 25% だけ骨粗しょう症のための診断・臨床的に処置を受けていた。
著者は年配の患者の胸部X線検査は脊椎のひびの存在を確認するために利用されることを提案している。