Reminding Doctors to Test Older People for
Osteoporosis Reduced Fractures, Health Care Costs
Just a simple personal reminder letter to family
doctors and patients about evaluating fracture patients for osteoporosis
significantly improved care at very low cost
April 18, 2013 - Osteoporosis is a condition that
is common, costly and undertreated. Low trauma fractures in older people
are a "red flag" for osteoporosis, but those at risk often are not
treated for the condition. Rates of osteoporosis testing and treatment
are typically less than 20 percent in the first year after a fracture.
Reminding primary care doctors to test at-risk
patients for osteoporosis can prevent fractures and reduce health care
costs, according to a recent study accepted for publication in The
Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).
"Sending family doctors and patients a reminder
letter about evaluating fracture patients for osteoporosis significantly
improved care at a very low cost," said William D. Leslie, MD, MSc, of
the University of Manitoba in Canada, and senior author of this study.
"The procedure more than paid for itself in the
long term it is projected to prevent fractures and save money."
The intervention involved two mail-based notices,
one sent just to the physicians of more than 4,000 patients with recent
fractures, and the other sent to both physicians and patients. The
notices to physicians were personalized letters that included bone
mineral density (BMD) testing guidelines and a flowchart of osteoporosis
management. The second intervention combined the physician letter with a
personalized letter to patients acknowledging their recent fracture and
recommending they see their primary care physician for an osteoporosis
These mail notices were inexpensive but effective.
The notice to physicians cost just $7.12 (Canadian) per patient, and the
note to physicians and patients cost $8.45. Within one year osteoporosis
treatments increased by 1.5-fold (4 percent) as a result of the
physician letter, and the physician-patient outreach increased treatment
rates by 1.8-fold (6 percent) in the same time span.
Economic simulations showed that for every 1,000
patients who received physician intervention, there were two fewer
fractures, two more quality-adjusted years of life gained and $18,000
"Simple educational strategies targeting doctors
and patients after a fracture have consistently failed to improve the
quality of osteoporosis care," said Leslie.
"The emergency doctors and orthopedic surgeons who
treat fractures are not the ones responsible for preventing the next
fracture and the family physicians who deal with prevention aren't
usually part of the team that treats the fracture.
Connecting everyone involved specialists, family
physicians and patients systematically allowed for better care. A
simple and very low-cost system using reminder letters can contribute to
addressing this 'care gap' and is a strategy that would be easy for
others to adopt."
Other researchers working on the study include: S.
Majumdar and D. Lier of the University of Alberta and the Institute of
Health Economics in Edmonton, Alberta, Canada.
The article, "Cost-Effectiveness of Two Inexpensive
Post-Fracture Osteoporosis Interventions: Results of a Randomized
Trial," appears in the May 2013 issue of JCEM.
Founded in 1916, The Endocrine Society is the
world's oldest, largest and most active organization devoted to research
on hormones and the clinical practice of endocrinology. Today, The
Endocrine Society's membership consists of over 16,000 scientists,
physicians, educators, nurses and students in more than 100 countries.
Society members represent all basic, applied and clinical interests in
endocrinology. The Endocrine Society is based in Chevy Chase, Maryland.
To learn more about the Society and the field of endocrinology, visit
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