Treatment of osteoporosis: missed opportunities in the hospital fracture clinic

Abstract

Aim:To identify what proportion of patients who, having sustained an initial distal radial fragility fracture and a subsequent femoral neck fracture, had had their osteoporosis addressed in the interval between the two events. Patients and Methods:The hospital electronic information system was used to identify all patients aged over 50 years treated for a distal radial fracture, in our fracture clinic, between 1995-2000. In addition all patients admitted to our hospital, during the same time period, with a femoral neck fracture were identified. Results: A study cohort of 74 patients were identified. The proportion of patients who received investigation of, or treatment for, osteoporosis between their wrist and femoral neck fracture was 8% whereas 84% did not. Conclusions: Current mechanisms for identifying patients with osteoporosis before they sustain a femoral neck fracture are inadequate.

A team approach: implementing a model of care for preventing osteoporosis related fractures

“…In spite of these difficulties, improvements in early referral rates have been realised, with consequent early instigation of treatment and reduction in lost opportunity for individuals to receive specialist assessment and ongoing management [2,5,9]. Greater awareness amongst staff, together with the inclusion of an osteoporosis fracture check list on the ED discharge summary, has reduced the incidence of discharge without referral and follow-up.…”

“…Of the survivors, 50% require long-term assistance and will be unable to walk unaided and 25% will require full-time nursing home care [7]. This, in turn, impacts on the availability and cost of residential care [5].The cost of hospitalisations alone for hip fractures in 2005 in Australia was estimated at A$8.5 million [2]. Tosteson et al [6] estimates the average cost of one hip fracture at US$40,000 for the acute and chronic care involved.…”

“…There is strong evidence indicating that early identification and treatment of osteoporosis is critical in order to prevent recurrent fractures in older people [2,5,9], however, for many, osteoporosis remains undiagnosed and therefore untreated. Treatment instigated early following a first fracture can decrease recurrent fracture rates by between 30% and 60% [2,5,9].…”

“…Treatment instigated early following a first fracture can decrease recurrent fracture rates by between 30% and 60% [2,5,9]. Bisphosphonate therapy alone has been shown to reduce fracture risk by between 50% and 70%; however, less than 10% of patients with diagnosed osteoporosis are commenced on this or any other bone-strengthening therapy [2,10].…”

“…Evidence suggests that refracture can be prevented resulting in significant outcomes to patients and healthcare budgets [2][3][4][5][6]. Success is contingent on the coordination of interprofessional practice and streamlining of referral and treatment pathways.…”