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Posted on 10.23.01
Preventing New Fractures from Osteoporosis: Improving Compliance with Guidelines
By Jason Olivieri, MPH
One of the leading challenges to elderly health is osteoporosis, a disease characterized by reduced bone mass and structural deterioration of bone tissue. The disease results in bones that are fragile and more likely to fracture.
Fractures from osteoporosis can have significant consequences, including increased mortality, pain, depression, and loss of independence. Among people of advanced age, residents of skilled nursing facilities (SNF) who have already had such a fracture are the most susceptible to the devastating potential of this disease.
Investigators from the University of Alabama at Birmingham (UAB) CERTs and the Duke University Claude D. Pepper Older Americans Independence Centers are developing an intervention study to improve care for such patients in Alabama and North Carolina.
Medical care providers do have effective prevention strategies for osteoporosis; for example, an increasing number of medications have been shown to reduce new fractures. As a result, several organizations, including the National Institutes of Health and the National Osteoporosis Foundation, have published guidelines for practice that emphasize the importance of evaluating and treating patients at risk for the disorder.
Despite strong evidence and guidelines, however, the monitoring and treatment of osteoporosis have been insufficient, according to several studies. The patterns and predictors of compliance with such guidelines by caregivers are not well understood.
The purpose of the UAB-Duke collaboration, then, is twofold:
- to identify barriers to compliance with current osteoporosis guidelines among SNF in the two states, and
- to perform a randomized, controlled study of an intervention designed to increase compliance.
The investigators are primarily interested in changing the prescribing behavior of SNF physicians with regard to drugs such as Fosamax (aledronate) and Actonel (risedronate). These drugs, which can reverse bone loss, have been shown to reduce the rate of fractures in several clinical studies.
Success in this trial could allow the investigators to apply this model of intervention to other healthcare organizations, to improve the treatment of their patients with osteoporosis and associated fractures