Project Summary

Osteoporosis is a disease that weakens bones so they may break easily. The risk for osteoporosis increases with age in both women and men. Osteoporosis affects 10 million older adults in the US. Osteoporosis is a common cause of broken bones in the hips and legs. Broken bones can lead to disability, nursing home placement, and death. Because of the dire consequences, a broken hip or leg is one of the most dreaded injuries for older adults. Many studies confirm that a simple regimen of exercise, healthy diet and bone-strengthening medications can improve overall recovery after a broken hip or leg. This regimen can prevent a person from becoming disabled, having future fractures, and even prevent death.

Many older adults have surgery in a hospital after breaking a hip or leg. Then they go to a skilled nursing facility (SNF) for rehabilitation. Care in SNFs varies greatly. Some patients do not receive the regimen known  to be most beneficial to improve bone health and recovery. Even patients who get exercise, healthy diet, and bone-strengthening medication in the SNF, may not continue with the regimen once they go home. Therefore, the OsteoPorotic fracTure preventION System (OPTIONS) program was developed. OPTIONS is a program that will integrate the regimen into the care that is provided in SNFs and after discharge to the community. OPTONS will provide information about exercise, diet, and bone-strengthening medication. OPTIONS will provide doctors, clinical staff, patients, and care partners with the information they need to carry out the best-practice regimen.

The research team is partnering with ProMedica, a large healthcare organization, with SNFs and community care sites across the United States. Twenty-four SNFs from different US areas will be included. A coin toss will be used to assign SNFs to the intervention (OPTIONS) or the control arm (enhanced usual care) of the study. Enhanced usual care is the care that is typically provided in SNFs after a fracture and with the addition of information about a publicly available fall prevention toolkit. An “implementation science” approach that requires input from a vast stakeholder community will be used throughout the study. These stakeholders include patients, care partners, clinicians, and professional organizations.

The primary research question is, can using OPTIONS in SNFs and in the community after discharge improve physical function and quality of life in older people in the year after a hip or leg fracture? Patient-reported outcomes, from 1320 patients across 24 facilities, will be measured. Outcomes that are important to patients have been selected. Specifically, patient-reported function and quality of life are being measured. Patient-reported falls and fractures are also being measured. The number of patients who die during the study will be tracked as well. The research team’s main hypothesis is that patients who receive OPTIONS will report better physical function (i.e., can walk and take better care of themselves) than those who receive enhanced usual care. Another hypothesis is that patients that receive OPTIONS will report a better quality of life than those who receive enhanced usual care.

This study will provide sound data about the effectiveness of OPTIONS. OPTIONS could then be spread to other SNFs and community-based programs. This would ensure that all older people receive the right care after a hip or leg fracture.

Project Information

Patricia Dykes, PhD, RN, MA
Denise Orwig, PhD, MS
Brigham and Women's Hospital
$13,035,048 *

Key Dates

60 months *
2022

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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Last updated: August 5, 2022