Majumdar SR et al. (2007) Use of a case manager to improve osteoporosis treatment after hip fracture. Arch Intern Med 167: 2110–2115

Patients who suffer a hip fracture are at increased risk of further fracture, but audits suggest that <20% of these patients receive osteoporosis treatment in the year after hip fracture. Majumdar et al. conducted a study in which patients with a hip fracture were randomly assigned to a case manager or to usual care. The case manager provided counseling, arranged BMD tests, and arranged bisphosphonate prescriptions for patients with low BMD.

The intervention and control groups each contained 110 patients. The median age of participants was 74 years; 37% reported a previous fracture and 60% were women. Within 6 months of fracture, 88 patients in the intervention group had received a BMD test, compared with 32 patients in the control group, and 56 patients in the intervention group were receiving bisphosphonate therapy, compared with 24 patients in the control group. Appropriate care was provided to 67 patients in the intervention group versus 26 patients in the control group. The case manager spent a median of 70 min per patient, and the cost per patient was US$50.

The authors conclude that a case manager can, at modest cost, improve considerably the standard of osteoporosis care for vulnerable patients.