To assess for differences between outcomes in the intervention and control groups, multi-level hierarchical modelling using the General Estimating Equation (GEE) approach was used to account for clustering to estimate the treatment effect as an odds ratio and test for significance [33, 34]. First-order interaction terms (specifically: sex by intervention status) were evaluated. The 95% confidence intervals and p values were calculated using the sandwich estimator of variance.

The analysis was carried out using R: A Language and Environment for Statistical Computing version 2.10.1 [35, 36]. The GEE models were fit using the R package geepack selleck kinase inhibitor version 1.0-17. Results Study flow Of the 54 eligible hospitals, 36 agreed to participate and

were randomly assigned to intervention or control group (18 in each group). We obtained 801 records for fracture patients within 3 months of their admission to the ED; 139 were received 3 months after fracture. Of these, 443 were excluded: 298 were unable to reach, 51 had died or were in long-term care, 43 lived outside of the hospital catchment area, 21 refused, 18 had previously been screened by a fracture clinic coordinator and 12 had significant cognitive or hearing impairment, resulting in 358 enrolled subjects (Fig. 1). Fig. 1 Flow of patients through the trial Cluster size was comparable between the groups with ten (range, 3–16) Unoprostone learn more in the intervention and ten (range, 4–18) in the control hospitals. Of those randomized, 52 from the intervention hospitals and 39 from the control hospitals were lost to follow-up

leaving a total of 267 subjects with complete data for analysis. The primary analysis is a ‘complete case’ and includes only those whose outcome is known [37]. A secondary analysis was the strict intention to treat analysis in which all randomized subjects were included. Baseline characteristics The mean age of the study participants was 66.0 years in the intervention and 65.4 in the control group; about two thirds were female and married. Twenty-seven percent had a history of a previous fracture since the age of 40 years, 20% were current smokers and 23% had fallen in the previous 12 months. Thirty-one percent had a BMD test in the previous 12 months, 25% self-reported a diagnosis of osteoporosis and 19% were currently taking osteoporosis medications. The most common fracture type was wrist (34%), followed by ankle (16%), rib (12%), shoulder (12%) and hip (8%). There was no significant difference in demographic and clinical characteristics among patients in the intervention and control groups (Table 1).