Oral Presentation ESA-SRB-NZSE-CaSR 2026 in conjunction with ENSA

Targeted alerts to primary care physicians improve osteoporosis treatment after minimal trauma fracture: Outcomes of the INTERCEPT cluster-randomised controlled trial (143543)

Mawson Wang 1 2 , Dominic Cavenagh 3 , Anurina Das 4 , Andrew D Auwyang 4 , Divia Mohandas 5 , Patrick Bolton 6 7 , Alice Knight 8 , Christian M Girgis 5 9 , Catherine D'Este 8 9 , Markus J Seibel 1 2
  1. Department of Endocrinology & Metabolism, Concord Hospital, Concord
  2. Bone Research Program, 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. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, 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. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

Background

Primary care plays a central role in co-ordinating osteoporosis management. However, up to 80% of patients with a minimal trauma fracture are neither investigated nor treated to prevent re-fracture. We trialled a novel integrated model of secondary fracture prevention in primary care with the aim to improve post-fracture osteoporosis management.

Methods

Patients referred for X-rays, CT or MRI for any indication and diagnosed with a potential osteoporotic fracture were identified using natural language processing. Referring primary care practices were randomised 1:1 to intervention (imaging report, fracture alert and management guidelines directly to the general practitioner) or usual care (imaging report only). Primary outcome was the proportion of patients receiving dual-energy X-ray absorptiometry (DXA) and/or a prescription for osteoporosis-specific pharmacotherapy within 3 months of randomisation. Secondary outcomes were the proportion of patients receiving blood tests or Chronic Disease Management Plans within 3 months; or a second prescription within 9 months. Outcome measures were ascertained through government data linkage.

Results

The trial included 942 patients from 318 practices, randomizing 458 patients/160 practices to intervention and 484 patients/158 practices to usual care. In the intervention group, 35% of patients received a DXA scan and/or prescription within 3 months, compared to 26% with usual care. The odds ratio of a DXA scan and/or prescription in the intervention group was 1.6 (CI:1.2-2.1) times that of usual care. The odds ratios for an initial prescription within 3, and a second prescription within 9 months were 1.9 (CI:1.3-2.7) and 1.9 (CI:1.3-2.9), respectively. The intervention had no effect on other secondary outcomes.  Females and those with vertebral fractures had higher odds of receiving pharmacotherapy. Increasing age was associated with up to 4-fold higher odds of treatment. 

Conclusion

This targeted intervention significantly improved post-fracture osteoporosis management and as a scalable approach may help close the osteoporosis care gap.