Simple explanation, letter improve osteoporosis treatment rates
A simple explanation of osteoporosis and a letter to the family physician on the importance of treatment can significantly increase osteoporosis treatment rates among patients older than age 65 who have had a hip fracture—particularly if that intervention occurs a few weeks after the patient is discharged from the hospital.
According to the authors of scientific paper 269, a simple intervention enlisting the patient’s help to involve the family physician can be effective, but the timing of the information may be even more significant.
The three-part intervention included a letter with specific recommendations for the family physician, a leaflet on osteoporosis treatment and fracture prevention for the patient and a 5- to 10-minute explanation of the importance of osteoporosis treatment, with specific instructions to “ask the family physician.” Three months after discharge, during a follow-up phone call, patients were asked the following questions:
Patients who were not receiving osteoporosis treatment at the three-month follow-up call received an explanation of osteoporosis and the need for treatment, and another letter was mailed to the family physician if requested. At the six-month follow-up, patients were again contacted by phone and asked the same questions.
At the three-month follow-up, “the majority of patients did not recall the intervention at all, making its efficiency questionable,” noted the authors. There was, however, a significant increase in the number of patients in the intervention group who were receiving treatment at six months.
From this, the authors conclude that “during the immediate postoperative period, the patient and his family are unable to respond to such interventions” and add that more time should elapse before the intervention is performed.
This prospective study with a historic control group involved 100 consecutive patients treated for osteoporotic hip fracture between November 2003 and May 2004 (intervention group) and 99 patients treated between September 2004 and June 2005 (control group). Age and gender demographics between the groups were similar.
“In the control group,” noted the authors, “out of 100 patients who received a general recommendation for osteoporosis treatment, 19 patients (19 percent) received bisphosphonates, 3 received calcium supplementation and 78 received no treatment.”
In the intervention group, 16 patients (19 percent) were receiving bisphosphonates after three months, with 14 patients receiving calcium supplementation and 54 patients receiving no treatment at all. More than half (57.8 percent) of patients in the intervention group did not remember that an explanation or leaflet was given.
At six months, after the second explanation and letter, 31 patients (39.2 percent) were receiving bisphosphonates, the number of patients receiving calcium supplementation increased from 14 to 16, and the number receiving no treatment dropped to 32 patients.
The lead researcher for Paper 269 was Leonid Kandel, MD, with David Schler, MD; Mayer Brezis, MD; Rivka Dresner Pollack, MD; Yoav Mattan, MD, and Meir Liebergall, MD, all of Hadassah-Hebrew University Medical School, Hadassah Medical Center, Jerusalem, Israel.