Attention controls Similar to the intervention hospitals, within 3 months of the ED visit for fracture, patients from the control hospitals received educational material and telephone counseling regarding fall prevention and home safety from the centralized coordinator. Patients were encouraged to visit their primary care physician

for a more detailed advice and NSC 683864 supplier medication review. They did not receive counseling or educational materials about osteoporosis. The coordinator administered the baseline questionnaire and obtained consent for the research assistant to collect follow-up data at 6 months. The control group did not receive the 3-month reminder phone GSK458 in vitro call. Outcomes and measurements The primary outcome was the proportion of patients self-reporting ‘appropriate management’, defined as receiving, within 6 months of fracture, either an osteoporosis medication (bisphosphonate, raloxifene or teriparatide) or normal BMD and prevention

advice. Previous research has shown excellent agreement between self-report and dispensing records for osteoporosis medications [28, 29] and self-report for having had a BMD test [30]. This composite outcome was chosen because unlike the other post-fracture care trials that excluded patients already taking osteoporosis medications [15–23], this trial included patients who were already on treatment for osteoporosis when they experienced a low trauma fracture. The Canadian guidelines LY294002 solubility dmso recommended that these patients should have their BMD reassessed and medications reviewed [1, 27]. Secondary outcomes were: the proportion of patients with a Thiamine-diphosphate kinase physician visit to discuss osteoporosis after fracture, and the proportion for which BMD was scheduled or performed. Sample size The sample size was based on a binary outcome (appropriate management—yes/no). In a survey of osteoporosis researchers and clinicians from Canada and the USA, the median response reported for a ‘minimal clinically

important difference’ for a post-fracture care intervention was 20% over and above ‘usual care’ [31]. From our demonstration project in five small communities in Ontario [14], we found that 31% of patients had a BMD test after fracture. We anticipated a cluster size of ten patients per hospital and an intra-cluster correlation coefficient of 0.01 [32]. Therefore, we needed to identify about 20 fracture patients in each of 30 hospitals to detect an effect size of 20% (intervention = 50% and controls = 30%) with 90% power. Therefore, the final sample was at least 300 patients (ten patients per cluster with 15 intervention and 15 control clusters). The level of statistical significance was set at p < 0.05. Randomization Hospitals that agreed to participate were assigned by simple random allocation to invention or attention control. Randomization was performed with a computer program by the statistician who was blind to the hospitals’ identity.