Effect of a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma non-hip fracture: A systematic review

Summary: The aim of this study was to identify the effect a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma fracture. A dedicated osteoporosis health professional improved investigation and management of osteoporosis. Osteoporosis management was enhanced, leading to the potential for future fracture prevention. 

Purpose: This study aimed to review the effect a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma fracture. 

Methods: We searched the electronic databases of Medline, EMBASE, CINAHL, Current Contents Connect, Joanna Briggs Institute EBP, and Cochrane from database development to April 2013, examined grey literature, and completed manual searches of reference lists to identify English language research that examined the effect that dedicated health professional input had on osteoporosis management with acute low trauma non-hip fracture in the outpatient setting. Outcomes were defined as the proportion of patients with investigation (bone mineral density (BMD) or blood screen); treated with vitamin D supplementation or antiresorptive agent; documented BMD reading change; recurrent fracture occurrence; or referral to specialist bone (osteoporosis) clinic. 

Results: All studies with a suitable control group showed an increase in BMD screening in the intervention group (odds ratio (OR) 5.4, 95% confidence interval (CI) 4.3- 6.9, P<0.0001). The effect on treatment initiation showed a significantly increased rate of antiresorptive ± vitamin D therapy (OR 5.3, 95% CI 4.1-6.8, P <0.0001). No studies examined improvement or decline in BMD guiding clinical practice as an outcome. Two studies showed reduced fracture recurrence. The osteoporosis health professional significantly increased referrals to a specialist bone clinic (OR 9.6, 95% CI 6.2-14.6, P<0.0001). 

Conclusions: The presence of a dedicated osteoporosis health professional coordinating a targeted intervention for outpatients with low trauma non-hip fracture improves investigation and management of osteoporosis, resulting in the potential for future fracture prevention.