Key outcomes are usually not reported in published fracture secondary prevention programs: results of a systematic review.

OBJECTIVE: A secondary analysis of a systematic review on interventions to improve osteoporosis (OP) investigation and treatment was conducted to examine reported key outcomes: (1) the cost of the intervention; (2) the proportion of patients taking OP medication beyond 6 months of the intervention; and (3) the proportion of patients who re-fractured. METHODS: Fifty-seven articles reporting on 54 studies (64 interventions) from 11 countries were included. Intervention studies to improve OP management were eligible if they were conducted in an orthopedic setting and included primary data on ≥20 patients presenting with a hip fracture or any fragility fracture. To compare outcome data across all interventions regardless of study design, an equated proportion (EP) using a denominator based on the intention-to-treat principle was derived. Whether a cost analysis had been conducted, the EP of patients who were taking medication beyond 6 months of the intervention, and the EP of patients who re-fractured during the study period were documented. RESULTS: Of the 54 studies, 2 reported a cost analysis and demonstrated that the interventions were at least cost-effective. The EP for medication use beyond 6 months of the intervention ranged from 17 to 56% for four studies. The EP for re-fracture ranged from 0 to 5% for four studies. CONCLUSION: Most interventions did not report key outcomes. In addition, authors used varying time frames for re-fracture and medication use, making direct comparisons impossible. Authors should consider including intervention costs, medication use beyond 6 months of the intervention, and re-fracture data in future fracture secondary prevention programs.

Medication initiation rates are not directly comparable across secondary fracture prevention programs: reporting standards based on a systematic review.

OBJECTIVE: To examine the methods used to calculate the reported medication initiation rates in secondary fracture prevention programs. STUDY DESIGN AND SETTING: A systematic review was conducted on postfracture interventions that aimed to improve osteoporosis management in an orthopedic environment. Two authors independently reviewed eligible articles to determine the numerator and denominator used to calculate the rates of antiresorptive medication initiation based on author reports. In interventions with numerator and denominator combinations that appeared to be comparable, we examined the inclusion and exclusion criteria to confirm comparability. RESULTS: Fifty-seven articles reporting on 64 interventions were eligible for the review. A total of 28 different combinations of numerators and denominators to calculate rates were reported for medication initiation across 49 of the 64 interventions. After examining the inclusion and exclusion criteria for rates that appeared to be comparable, the highest number of interventions with a comparable rate was 3. CONCLUSION: Reporting processes for antiresorptive medication initiation outcomes in secondary fracture prevention programs used heterogeneous standards that prevented useful comparison of programs. Applying different numerator and denominator combinations meant that the same observed number of patients could have resulted in different reported rates. We propose standards for reporting medication initiation rates in such programs.