Study of Current Practice Evaluating the Efficacy of a Mobile Short Message Service (SMS) on Post-fracture Management.
Study of Current Practice Evaluating the Efficacy of a Mobile Short Message Service (SMS) on Post-fracture Management.
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.
Inclusion Criteria:

 -  Patients of more than 50 years old

 -  Low trauma non vertebral fracture

 -  Ambulatory patient

 -  Direct access to mobile phone (or access with the help of a close person) and ability
 to communicate via SMS.

 -  Patient who doesn't oppose to his participation in the study

 -  Affiliation to the social security

 Exclusion Criteria:

 -  Patients hospitalized for the fracture in the orthopaedics department because these
 more severe patients have a systematic screening and management of osteoporosis.

 -  Fractures whose location is not suggestive of osteoporotic fracture (cervical spine,
 skull, hands, fingers, toes)

 -  Pathological fractures (cancer or myeloma)

 -  Traumatic fractures

 -  Severe alterations of cognitive functions

 -  Resident subjects except Paris and the surrounding area