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A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada


Summary — This study evaluated a multi-component intervention (educational materials and outreach visits) to increase knowledge and improve post-fracture care management in five rural communities in Canada. One hundred and twenty-five patients pre- intervention and 149 post-intervention were compared. No significant improvement in post-fracture care was documented suggesting that a more targeted intervention is needed.

Introduction — Currently, the majority of patients with a low trauma fracture are under-investigated and under-treated for osteoporosis. We set out to evaluate an educational intervention on increasing knowledge of post-fracture care among healthcare professionals (HCPs) and fracture patients and on improving post-fracture management.

Methods — We studied five rural communities in Ontario, Canada, using a multi-component intervention (“Behind the Break”), including educational material for HCPs and patients and educational outreach visits to physicians. The study had a historical control, non-equivalent pre/post design. Telephone surveys were carried out with individuals ≥40 years of age who had a low trauma fracture in 2003 (n = 125) or in 2005 (n = 149). Family physicians and emergency department staff were also surveyed.

Results — A total of 4,207 educational packages were distributed. Seventy-three percent of family physicians had an outreach visit. Two-thirds indicated that they received enough information about post-fracture follow-up to incorporate it into their practice. Despite this, no significant improvement in post-fracture care was documented (32% in the “pre” group had a bone mineral density test and 25% in the “post“ group). Of those diagnosed with osteoporosis, the majority were prescribed a bone-sparing medication (63% “pre” and 80% “post”).

Conclusion — A more targeted intervention linking fracture patients to their physician needs to be evaluated in rural communities.



Jaglal SB, Hawker G, Bansod V, Salbach NM, Zwarenstein M, Carroll J, Brooks D, Cameron C, Bogoch E, Jaakkimainen L, Kreder H. Osteoporos Int. 2009; 20(2):265-74. Epub 2008 Jun 3.