Low Trauma Non Vertebral Fracture Clinical Trial
Official title:
Evaluation of the Efficacy of a Mobile Phone Short Message Service on Post-fracture Management for Patients Who Consult to the Emergency Department
The purpose of the study is to show that the standardized sending of SMS improve the bone mineral density (BMD) screening of patients seen in the Emergency department for low trauma fracture.
Osteoporosis is a significant health problem in the older population affecting at least 40%
of women and 15 % of men over the age of 50 years. Fracture leads to increased morbidity and
mortality and healthcare costs as well as predisposing to future fractures. Patients with a
history of low-energy fracture are at significantly increased risk for further fractures in
the short-term. There is a universal consensus supported by high-quality randomized trial
evidence for secondary prevention: patients with low-trauma fragility fractures should have
BMD testing and most of them would benefit from anti-osteoporotic treatment There is,
unfortunately, also a well-documented and near-universal gap between evidence-based best
practice and usual care for patients with fragility fractures. Although osteoporotic
fracture indicates a two- to threefold increased risk of future fracture, only one in five
patients receive medical intervention after sustaining an osteoporotic fracture. Diverse
post fracture interventions have been developed for improving osteoporosis diagnosis and
treatment: provided educational materials to patients and/or primary physician, use of
medical reminders, more intensive interventions using osteoporosis case manager (nurse,
doctor) and fracture liaison service. the most effective post fracture interventions are
those which are more proactive, complex, time consuming, coordinator manager dependant, and
costly. Taking account the costs and the humans resources needing, we propose to improve
post fracture patient management using mobile telecommunication already used for other
chronic diseases management. There is no study about the use of phone short message service
(SMS) support in the field of osteoporosis, especially in the post-fracture management: bone
mineral density (BMD) screening, anti-osteoporotic treatment initiation and monitoring and
improvement of adherence. One of the limitations could be the use of phone mobile in these
older patients. We assessed the number of mobile phone users among 100 consecutive subjects
who were hospitalized for non vertebral fracture (mean age 69.5 years (50-98); 58 women and
42 men) in the Emergency department of Cochin hospital: 61 % had a mobile phone and used
SMS; 61% have a mobile phone.
We propose to assess the efficacy of the use of SMS support to improve the screening and the
initiation of antiosteoporotic treatment in patients with low trauma non vertebral fracture,
who consult in Emergency department.
This is a study of current care, monocentric, randomized, open. 170 patients will be
followed for 6 months. The group control will receive the usual recommendations to make an
appointment of realization of bone densitometry. The SMS group will receive 3 SMS (at 15
days, 5 weeks and 3 months) after consulting the time of consultation in Emergency
department, and will be called during 10 minutes at 6 months by a nurse.
The results of this study will have an important impact for the postfracture management in
the field of osteoporosis . Indeed, if we demonstrate that the use of SMS improves the BMD
screening and antiosteoporotic treatment initiation, we plan to assess in a large randomized
controlled trial whether mobile phone communication can decrease the risk of new fracture
comparatively to usual care in patients with low trauma fracture could use.
;
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label