Targeted GP alerts improve osteoporosis treatment after minimal trauma fracture: Outcomes of the INTERCEPT multicentre cluster randomised controlled trial  — ASN Events
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  3. Targeted GP alerts improve osteoporosis treatment after minimal trauma fracture: Outcomes of the INTERCEPT multicentre cluster randomised controlled trial 

Targeted GP alerts improve osteoporosis treatment after minimal trauma fracture: Outcomes of the INTERCEPT multicentre cluster randomised controlled trial  (#2)

Mawson Wang 1 2 , Dominic Cavenagh 3 , Anurina Das 4 , Andrew Auwyang 4 , Brett Williams 4 , Daniel Moses 4 , Bruce Armstrong 5 , Divia Mohandas 4 , Patrick Bolton 6 7 , Alice Knight 8 , Christian M Girgis 9 , Catherine D'Este 8 10 , Markus J Seibel 1 2
  1. Department of Endocrinology & Metabolism, Concord Hospital, Concord
  2. Bone Biology Group, ANZAC Research Institute, Concord, NSW, Australia
  3. Centre for Women's Health Research, University of Newcastle, Newcastle, New South Wales, Australia
  4. Spectrum Medical Imaging, Sydney, NSW , Australia
  5. Professor Emeritus, University of Sydney, Sydney, NSW, Australia
  6. Centre for Primary Health Care and Equity, UNSW, Sydney, NSW , Australia
  7. South East Sydney Local Health District, Sydney, NSW , Australia
  8. Sax Institute, Glebe, NSW , Australia
  9. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
  10. School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW , Australia

Background: Up to 80% of patients are not investigated or treated for osteoporosis following a minimal trauma fracture. Primary care has been proposed as the mainstay of osteoporosis care. We assessed the effectiveness of an integrated model of secondary fracture prevention in primary care on rates of osteoporosis-directed investigations and treatment.

Methods: We conducted a cluster-randomised controlled trial across metropolitan Sydney between September 2023-November 2024. Patients with a potential osteoporotic fracture on imaging (X-ray, CT, MRI) were identified at community-based radiology providers and a tertiary-level hospital using natural language processing tools. Referring primary care practices were randomised 1:1 to the intervention (imaging report plus additional fracture alert directly to the GP along with osteoporosis management guidelines) or usual care (imaging report only). The primary outcome was the proportion of patients who underwent dual-energy X-ray absorptiometry (DXA) and/or filled a prescription for osteoporosis-specific pharmacotherapy within 3 months of randomisation. Secondary outcomes were the proportion of patients who underwent an osteoporosis-related blood test or were initiated on a chronic disease management plan (CDMP) within 3 months. Outcomes were obtained through government data linkage.

Results: A total of 942 patients from 318 GP practices were included in the study. Compared to usual care, a higher proportion of patients in the intervention group were referred for a DXA scan and/or filled a prescription within 3 months (35.4% vs. 26%, p<0.01). The odds of having a DXA scan and/or filling an osteoporosis prescription was 1.6 times higher among patients of GPs randomised to the intervention group relative to usual care (OR 1.61, CI: 1.21-2.14) while the odds of having a script was almost double (OR 1.87, CI: 1.26-2.76). Increasing age over 70 years led to progressively higher odds of filling a prescription despite lower odds of DXA screening. There was no effect on uptake of osteoporosis-related blood test or initiation of CDMP.

Conclusion: This simple and inexpensive intervention targeting primary care through semi-automated fracture identification tools resulted in significant improvements in osteoporosis management, particularly in older patients. Integration of post-fracture management into primary care is a scalable approach to closing the osteoporosis care gap.