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that increased awareness of orthopaedic surgeons after educations improved the detection rate of osteoporosis from 20.1% to 45% and treatment rates from 15.1% to 32.2%.[12] However, during follow-up, maintenance of osteoporosis medication was steeply reduced 12% at mean of 9.5 months follow-up.[12] In addition, follow-up observational study after finishing interventional study was disappointed,[13] detection and treatment rate of osteoporosis following hip fracture in same cohort from 2008 to 2011 were still not enough (mean, 36.4% [range, 24.2%-40.5%]; mean, 23.1% [range, 20%- 29%], respectively).[13] Therefore, we designed additional intervention studies for patients with hip fracture are required to further improvement of osteoporosis treatment rates after hip fracture. This prospective intervention multicenter study was to determine whether an education program after surgery in patients with hip fracture could increase the osteoporosis treatment rate after a hip fracture, and to confirm maintenance of osteoporosis medications. METHODS The design and protocol of this study was approved by the Institutional Review Board (IRB) at our hospital. Patients were informed their medical data might be used in a scientific study and provided consent. 1. Participants This prospective interventional multicenter study was performed on patients over 50 years of age who were admitted for a hip fracture between November 1, 2014 and September 30, 2015 at the six hospitals. There are six hospitals (one university hospital and five general hospitals) on the island with orthopedic department and emergency admission facilities and all hospitals used dual energy Xray absorptiometry (DXA) to determine bone mineral densities. Medical charts and radiological records were reviewed. Patients who met the diagnostic criteria of a femoral neck or intertrochanteric fractures based on the International Classification of Diseases, 10th revision (ICD-10; S720, S721) and who were over 50 years of age at fracture diagnosis were enrolled. The exclusion criteria were; a non-resident of Jeju Island, a pathologic bone fracture (metastasis), serious medical illness including chronic renal failure, cancer history, mental illness, and refusal of participating study. Diagnosis at admission, mechanism of injury, detection of osteoporosis (DXA), and procedures performed during hospitalization, and discharge medications were then extracted and analyzed. 2. Statistical power and sample size justification We calculated the required study sample size using the 2008 to 2011 data, in which the initiation rate of osteoporosis treatment was 23.1% (218/945 patients).[13] Based on a power of 80%, significance level of 5%, and an estimated increasing rate of osteoporosis treatment of 17.3% in the patients who were diagnosed with hip fracture, the inclusion of 112 patients was estimated as optimal sample size. Since we expected a drop-out rate of 20% during follow-up due to the high mortality rate after hip fracture, we included 135 patients. 3. Intervention Prior to start intervention study, all of orthopaedic surgeons and assistants in the cohort completed standardization for patient’s education. To standardization of patient’s education, all orthopaedic surgeon and participant were provided with education sessions at prior to study. The education program included the relationship between osteoporosis and hip fracture, necessity of DXA for the detection of osteoporosis, importance of osteoporotic drugs in its treatment and routine follow-up for medication. After acquiring informed consent, patients at six hospitals were provided with education sessions during admission and brochures for increasing osteoporosis management. These education sessions involved providing information on the knowledge of osteoporosis, exercise and foods for preventing osteoporosis, the efficacy of DXA for the diagnosis of osteoporosis, the effectiveness of osteoporotic drugs and the importance of follow-up for the management of osteoporosis and of routine orthopaedic follow-up. Diagnosis at admission, mechanism of injury, detection of osteoporosis (DXA), procedures performed during hospitalization, and discharge medications were extracted from hospital records and analyzed. Osteoporosis treatment was Improvement of Osteoporosis Medication after Intervention https://doi.org/10.11005/jbm.2018.25.2.107 http://e-jbm.org/ 109 defined as medication including a selective estrogen receptor modulator (SERM), bisphosphonate, or calcitonin therapy or parathyroid hormone (PTH) therapy. Treatment initiation and duration were confirmed by reviewing medical records at 6 months and 12 months after discharge from hospital. Mortality status of the patients was identified from hospital record and/or interview with patient’s family. In addition, a death certificates at the National Registry Office were search for information on patients lost to follow-up. 4. Primary and secondary end points The primary study outcome was detection rate of osteoporosis (DXA) and rate of osteoporosis medication at 6 months after discharge from hospital. Secondary outcome was treatment rate of osteoporosis at 12 months follow-up. 5. Statistical analysis The χ2 test was used to analyze categorical variables. Pvalues were reported two sided, with P<T-score<-1) and four patients in normal.
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