Missing a therapeutic window of opportunity: an audit of patients attending a tertiary teaching hospital with potentially osteoporotic hip and wrist fractures.
OBJECTIVE
To establish the rate of and the predictors for performance of a bone mineral density (BMD) test and the treatment of osteoporosis in an at-risk cohort of patients attending a tertiary teaching hospital with fracture possibly related to osteoporosis.


METHODS
A list of all patients between ages 40 and 85 who had been admitted to a tertiary teaching hospital in the last 18 mo with hip fracture or seen in the accident and emergency department with a wrist fracture over the last 30 mo was obtained from computer records; those patients were invited to participate in the audit. In a followup telephone questionnaire, they were queried about potential risk factors for osteoporosis and subsequent fracture, the performance of a BMD test, any information received on osteoporosis and the source of this information, and the prescription of any treatment for osteoporosis.


RESULTS
In total, 218 patients were included in the audit from a potential 374 eligible patients. The majority were female (78%), with hip and wrist fractures in 42% and 58%, respectively; 32% subsequently had BMD measured and 39% were offered treatment for osteoporosis. Ninety-four percent of patients had heard of osteoporosis, with the major source of information being the media (83%) and friends (23%), with little information from the medical profession (34%). The major predictors for a patient to have a subsequent BMD test were female sex (OR 3.4, 95% CI 1.3-9.9), history of a previous fracture after the age of 50 (OR 2.3, 95% CI 1.0-5.6), family history of osteoporosis (OR 3.5, 95% CI 1.3-9.5), or the use of concurrent medications with a potential to cause osteoporosis (OR 2.5, 95% CI 1.1-5.8). The main predictors of treatment for osteoporosis being offered were age (risk increased by 1.04 for every year of life), abnormal result on the BMD test (OR 19, 95% CI 6-60), history of fracture after the age of 50 (OR 2.6, 95% CI 1.1-6.7), and a history of fracture with minimal trauma (OR 2.6, 95% CI 1.1-4.2). There was a range of treatments offered, with calcium supplementation alone accounting for 60% of treatments.


CONCLUSIONS
Osteoporosis was overlooked by medical practitioners responsible for the care of this at-risk patient cohort, with little evidence of the medical profession offering information, further investigation, or treatment of patients who presented with a probable osteoporotic fracture of the hip or wrist. This suggests that greater education of the accident and emergency and orthopedic medical staff as well as the general public is required concerning this opportunity to investigate and treat symptomatic osteoporosis.
Smith
M D
MD
Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia.
Ross
W
W
Ahern
M J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism; D010353:Patient Education as Topic; D012307:Risk Factors; D013021:South Australia / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014954:Wrist Injuries / Q000453:epidemiology* / Q000209:etiology