TY  - JOUR
PY  - 2018//
TI  - Comparing Strategies Targeting Osteoporosis to Prevent Fractures after an upper extremity fracture (C-STOP Trial): a randomized controlled trial
JO  - Journal of bone and mineral research
A1  - Majumdar, Sumit R.
A1  - McAlister, Finlay A.
A1  - Johnson, Jeffrey A.
A1  - Rowe, Brian H.
A1  - Bellerose, Debbie
A1  - Hassan, Imran
A1  - Lier, Douglas A.
A1  - Li, Stephanie
A1  - Maksymowych, Walter P.
A1  - Menon, Matthew
A1  - Russell, Anthony S.
A1  - Wirzba, Brian
A1  - Beaupre, Lauren A.
SP  - 2114
EP  - 2121
VL  - 33
IS  - 12
N2  - We compared osteoporosis care after upper extremity fragility fracture using a low-intensity Fracture Liaison Service (FLS) versus a high-intensity FLS in a pragmatic patient-level parallel-arm comparative effectiveness trial undertaken at a Canadian academic hospital. A low-intensity FLS (active-control) that 'identified' patients and notified primary care providers was compared to a high-intensity FLS (case manager) where a specially-trained nurse 'identified' patients, 'investigated' bone health and 'initiated' appropriate treatment. 361 community-dwelling participants 50 years or older with upper extremity fractures who were not on bisphosphonate treatment were included; 350 (97%) participants completed 6-month follow-up undertaken by assessors blinded to group allocation. The primary outcome was difference in bisphosphonate treatment between groups 6-months post-fracture; secondary outcomes included differences in bone mineral density (BMD) testing and a pre-defined composite measure termed "appropriate care" (taking or making an informed decision to decline medication for those with low BMD; not taking bisphosphonate treatment for those with normal BMD). Absolute differences (%), relative risks (RR with 95% confidence intervals [CI]), number-needed-to-treat (NNT) and direct costs were compared. 181 participants were randomized to active-control and 180 to case-manager using computer-generated randomization; the groups were similar on study entry. At 6 months, 51 (28%) active-control vs 86 (48%) case-manager participants started bisphosphonate treatment (20% absolute difference; RR 1.70 [95%CI 1.28-2.24]; p < 0.0001; NNT = 5). Of active-controls, 108 (62%) underwent BMD testing compared to 128 (73%) case-managed patients (11% absolute difference; RR 1.17 [95%CI 1.01-1.36]; p = 0.03). Appropriate care was received by 76 (44%) active-controls and 133 (76%) case-managed participants (32% absolute difference; RR 1.73, [95%CI 1.43-2.09]; p < 0.0001). The direct cost per participant was $18 Canadian (CDN) for the active-control intervention compared to $66 CDN for the case-manager intervention. In summary, case-management led to substantially greater improvements in bisphosphonate treatment and appropriate care within 6-months of fracture than the active control. This article is protected by copyright. All rights reserved.<br><br>This article is protected by copyright. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 0884-0431
UR  - http://dx.doi.org/10.1002/jbmr.3557
ID  - ref1
ER  -