Authors: P Casez B Uebelhart JM Gaspoz S Ferrari M LouisSimonet R Rizzoli
Publish Date: 2006/04/22
Volume: 17, Issue: 7, Pages: 965-970
Abstract
Introduction Vertebral fractures in older persons are strong predictors of subsequent fracture risk but remain largely underrecognized To evaluate the impact of an educational intervention on the recognition of vertebral fractures and the prescription of antiosteoporosis treatment among general internists we conducted a prospective study in a service of general internal medicine of a large university teaching hospital in Geneva Switzerland During a 35month observation period phase 1 all lateral spinal or chest radiographs performed on consecutive inpatients over 60 years were reviewed by two independent investigators and vertebral fractures were graded according to their severity Methods Results were compared with radiology reports and general internists’ discharge summaries During the following 2month intervention period phase 2 internists were actively educated about vertebral fracture identification by means of lectures posters and flyers Radiologists did not receive this educational strategy and served as controls Results Among 292 consecutive patients 54 men range 60–97 years included in phase 1 85 29 were identified by investigators as having at least one vertebral fracture radiologists detected 29 34 and internists detected 19 22 During the intervention phase 58 34 of 172 patients were identified with vertebral fractures by investigators radiologists detected 13 patients 22 whereas among internists the detection rate almost doubled 25/58 patients 43 p=0008 compared to phase 1 The percentage of patients with vertebral fracture who benefitted from an osteoporosis medical management increased from 11 phase 1 to 40 phase 2 p003 Conclusions Our findings confirm the large underrecognition of vertebral fractures irrespective of their severity and demonstrate that a simple educational strategy can significantly improve their detection on routine radiographs and consequently improve osteoporosis managementPierre Casez managed the protocol examined all of the Xrays collected and analyzed the data wrote the manuscript Brigitte Uebelhart examined all the Xrays and contributed to the data analysis and to the writing of the paper Martine LouisSimonet JeanMichel Gaspoz and Serge Ferrari contributed to the protocol design participated in the data analysis and to the writing of the paper René Rizzoli designed the protocol contributed to the data analysis and to the writing of the paperWe are indebted to the members of the Department of Radiology for their collaboration We thank Dr M Kossovsky for his valuable help in the statistical analysis and Mrs R Sudan for her careful reading of the manuscript This survey was made possible thanks to grants from the Geneva University Hospitals support of the investigator Rene Rizzoli had full access to all of the data in the study and takes the responsibility for the integrity of the data and the accuracy of the data analysis
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