The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures

Abstract

BackgroundThe purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures.MethodsA retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 years of age, the frequencies of diagnostic bone density scan for osteoporosis, and the prescription for the osteoporosis medication were analyzed and compared.ResultsA search of database identified 48,351 hip fractures, 141,208 spine fractures, and 11,609 proximal humeral fractures in patients more than 50 years of age in 2010. Among these patients, 12,097 (25.0%) of hip fractures, 41,962 (29.7%) of spine fractures, and 1,458 (12.6%) of proximal humeral fractures underwent diagnostic bone density scan (p < 0.001); 4,773 (9.9%) of hip fractures, 27,261 (19.3%) of spine fractures, and 639 (5.5%) of proximal humeral fractures were managed with at least one medication approved for the treatment of osteoporosis (p < 0.001). Furthermore, 1,217 (2.5%) of hip fractures, 7,271 (5.2%) of spine fractures, and 188 (1.6%) of proximal humeral fractures received diagnostic bone density scans as well as osteoporosis medications (p < 0.001). Younger patients (50–69 years of age) were less likely to be evaluated and managed for osteoporosis relative to older patients (≥ 70 years of age) (p < 0.001); and men were less likely to be evaluated and managed for osteoporosis relative to women (p < 0.001).ConclusionsCurrent physicians' practice pattern may be inadequate for the diagnosis and treatment of osteoporosis in patients of proximal humeral fractures over the age of 50 years. Additional study and educational programs are necessary to improve this care gap, beginning with physicians who are responsible for the fracture treatment and shoulder diseases.

Cortical Thickness Index of the Proximal Femur: A Radiographic Parameter for Preliminary Assessment of Bone Mineral Density and Osteoporosis Status in the Age 50 Years and Over Population

“…Several epidemiologic and clinical studies have demonstrated significant differences between males and females regarding the prevalence of osteoporosis, fracture risk, mortality risk after fracture, and bone geometry and strength. 20 21 22 23 24) For this reason, we suggest that males and females should be studied separately on the issues related to osteoporosis.…”

Factors Affecting Bone Mineral Density Measurement after Fracture in South Korea

“…Bone mineral density (BMD) measurement is the first important step to investigate and manage patients with osteoporosis. [ 17 ] That is the important opportunity to initiate secondary prevention in patients with previous osteoporotic fracture. [ 18 ] In fact, a few empirical studies have already dealt with this issue in Korea.…”

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

“…While many such studies are based in North America [19-22, 25, 26, 28], our study along with several Fig. 2 The treatment gap in the United Kingdom stratified according to fracture location (all, hip, spine, non hip non spine, and wrist fractures, respectively) and time period others demonstrate that the treatment gap seems to be a universal problem [23,24,30], also pertaining to European healthcare systems with a high level of access. Previous longitudinal studies have demonstrated an increasing treatment gap over time [25,26], and while our study provides more recent data with significant differences between the UK, Catalonia, and Denmark, the overall impression is that the gap is stable or increasing in recent years.…”

“…Despite such evidence-based recommendations, a significant post-fracture treatment gap is known to prevail across healthcare systems and settings [19][20][21][22][23][24][25][26][27][28]. Several publications report that in some countries as few as 10-20% of patients with fragility fractures go on to receive AOM [23][24][25][26][27], with this gap being more pronounced in men as well as in the elderly [20,26,29]. Despite the attention given to the importance of closing the treatment gap, long-term time trends seem to indicate that the gap has even been increasing in recent years [25,26].…”