One fracture is enough!: Experience with a prospective and consecutive osteoporosis screening program with 239 fracture patients

Abstract

Background Fracture and low bone mineral density both have strong predictive value for future fractures. The risk of future fractures can be reduced by medical treatment if patients with osteoporosis are identified, for example by screening fracture patients for low bone mineral density. We suggest that these screening routines be organized at orthopedics departments and we report our experience with such a screening system.Patients and methods We screened all patients between 50-75 years of age with a wrist, vertebral, proximal humerus, or hip fracture visiting our orthopedics department by measuring bone mineral density (BMD) using DEXA scans. After diagnosis, the patients were referred to their primary care physician for treatment.Results Between November 1, 2002, and October 31, 2003, 239 patients were investigated and only 13% had normal BMD values. 45% of the patients were diagnosed with osteopenia and 42% with osteoporosis.Interpretation Screening of fracture patients who visit an orthopedics department appears to be an effective way of identifying individuals with low bone mineral density. The screening routines can be organized as an osteoporosis team consisting of a doctor, a nurse and a secretary at each department. Today, these patients are largely undetected and untreated-at least in our region. In our series, only 13 patients had been DEXAscanned and were treated by antiresorptive drugs at the time of fracture.

Structural parameters of normal and osteoporotic human trabecular bone are affected differently by microCT image resolution

“…It is mainly a result of decreased estrogen levels, and the disease is associated with a markedly increased risk of skeletal fractures [2,3]. Osteoporosis is characterized by increased bone fragility and susceptibility to fractures [4], and it has been shown that early diagnosis of osteoporosis is essential for the prevention of future fractures [5,6]. Current diagnostics of osteoporosis are largely based on the measurements of areal bone mineral density (BMD [g/cm 2 ]), using dual energy X-ray absorptiometry (DXA) of the proximal femur or the lumbar spine as set forth by the WHO [7].…”

A review of patient-centred post-fracture interventions in the context of theories of health behaviour change

“…Forty-two studies were included in the final review [37,39,. Twenty-five of these studies described 19 osteoporosis screening or management programs incorporated in clinical care, while remaining 17 studies described 16 studyspecific interventions (randomized controlled trials, controlled trials, cohort studies and other interventions).…”

“…The orthopaedic environment (fracture clinic, emergency department, orthopaedic office, in-patient orthopaedic ward) is the setting with the highest concentration of fragility fracture patients who are in need of osteoporosis management. Previous research has shown that screening an entire population for osteoporosis is not cost-effective; however, screening fragility fracture patients is cost-effective [37,38]. A wide range of post-fracture interventions have been created and implemented within the orthopaedic environment as this is a setting where the concentration of fragility fracture patients is the highest and where delivering interventions is cost-effective [10,37,[39][40][41][42][43][44].…”

Comparative pharmacoeconomic analysis of the use of Bonviva® (ibandronat) to prevent fractures in postmenopausal osteoporosis

“…Еще одной проблемой, обсуждаемой многими авто-рами, является недостаточная диагностика ОП у лиц с МП [7][8][9][10]. В этих проспективных наблюдениях частота прове-дения денситометрии у лиц с МП составляла от 9 до 15%, причем во время госпитального лечения по поводу перело-мов этот показатель не превышал 5%.…”