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HipWatch: Osteoporosis Investigation and Treatment After a Hip Fracture: A 6-Month Randomized Controlled Trial

¹ University of British Columbia Center for Hip Health, Vancouver, Canada.
² Vancouver Coastal Health Research Institute, Canada.
Departments of ³ HealthCare and Epidemiology, ⁴ Orthopaedics,⁵ Physical Therapy, and ⁶ Family Practice, University of British Columbia, Vancouver, Canada.

Address correspondence to Karim Khan, MD, PhD, University of British Columbia, Center for Hip Health, David Strangway Building, Suite 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3. E-mail: karim.khan{at}ubc.ca

Objective. We aimed to determine whether a novel Patient Empowerment and Physician Alerting (PEPA) intervention would improve the proportion of seniors who were investigated and treated for osteoporosis after hip fracture.

Methods. We undertook a 6-month randomized controlled trial (RCT) in 48 women and men 60 years old who had suffered a hip fracture and were admitted to a tertiary-care university hospital. The primary outcome measure was the proportion of participants offered one or more osteoporosis-specific ‘best practices' measured using the Diagnosis and Management Questionnaire (DMQ). Participant responses were validated in part by physician report.

Results. In the PEPA intervention group, 19 (68%) were offered one or more components of best practice care compared with 7 (35%) in the ‘usual care’ group (p <.05). In the PEPA group, 15 (54%) (p <.01) were prescribed bisphosphonate therapy, 8 (29%) (p <.01) had a bone mineral density scan, 11 (39%) were prescribed calcium and vitamin D (p =.32), and 9 (32%) (p <.01) were prescribed exercise. In the usual care group, 0 (0%) were prescribed bisphosphonate therapy, a bone mineral density assessment, or exercise and 6 (30%) were prescribed calcium and vitamin D.

Conclusions. This simple, inexpensive PEPA intervention resulted in far superior clinical management than did usual care in a population at high risk of future hip fracture.