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Diana Bradley, Staff Writer | September 30, 2011
New research highlighting the benefits of reporting fractures suggests an intervention program could improve care for at-risk fracture patients.

The study, presented at the American Society for Bone and Mineral Research 2011 Annual Meeting on Sept. 18, involved radiologists informing primary care physicians of patients' vertebral fractures identified on X-rays taken for alternative purposes.

Current guidelines dissuade radiographic screening for the general public's vertebral fractures; furthermore, patients are unlikely to report non-troublesome symptoms to their doctor. Because of this, two thirds of vertebral compression fractures remain undetected, said the study's lead author, Dr. Sumit Majumdar, associate professor in the division of general internal medicine at the University of Alberta in Calgary, Canada, in a Medscape News article.

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According to osteoporosis experts, patients with a fracture and osteoporosis have a 20-fold increased risk of having another fracture without treatment; alternatively, evidence-based treatments can halve fracture risks.

The study's authors suggested that chest X-rays older patients receive for a plethora of other reasons allow radiologists to identify otherwise undetected fractures and improve care. However, only 60 percent of moderate to severe fractures on chest X-rays are reported by board-certified radiologists. In addition, doctors don't want to pass the information onto patients -- in April 2010, the Journal of the American College of Radiology reported that most doctors fear allowing patients access to their imaging test results "could lead to increased patient anxiety and unrealistic demands on physician time."

The study included 240 patients aged 60 and older who had been discharged from emergency departments with vertebral fractures and left untreated for osteoporosis.

Of these patients, half went to a physician intervention group where the radiographer sent a report to patients' primary care physicians describing the fracture and including an evidence summary signed by local osteoporosis experts. The other patients were assigned to a control group and after three months, those who remained untreated joined a counseling group where they received the same information as their primary care physician. A registered nurse with osteoporosis expertise also gave them a 10-minute counseling session.

In the end, the physician intervention group had a significant increase in osteoporosis treatment, BMD testing and the conjunction of treatment and BMD testing, when compared with the control group. On the other side, 16 percent of patients in the counseling group had an improvement in BMD testing or osteoporosis treatment, compared with the physician intervention group.

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