Evaluation and management of osteoporosis following hospitalization for low-impact fracture.
OBJECTIVE
To evaluate the pattern of osteoporosis evaluation and management in postmenopausal women who present with low-impact (minimal trauma) fracture.


METHODS
Retrospective chart review of patients admitted with a fracture in the absence of trauma or bone disease. Telephone follow-up survey was conducted at 12 months after discharge to collect information on physician visits, pharmacological therapies for osteoporosis, functional status, and subsequent fractures.


METHODS
Postmenopausal women admitted to a hospital in St. Paul, Minnesota between June 1996 and December 1997 for low-impact fractures were identified. Low-impact fracture was defined as a fracture occurring spontaneously or from a fall no greater than standing height. Retrospective review of 301 patient medical records was conducted to obtain data on pre-admission risk factors for osteoporosis and/or fracture, and osteoporosis-related evaluation and management during the course of hospitalization. Follow-up 1 year after the incident fracture was obtained on 227 patients.


RESULTS
Two hundred twenty-seven women were included in the study. Osteoporosis was documented in the medical record in 26% (59/227) of the patients at hospital discharge. Within 12 months of hospital discharge, 9.6% (22/227) had a bone mineral density test, and 26.4% (60/227) were prescribed osteoporosis treatment. Of those who were prescribed osteoporosis treatment, 86.6% (52/60) remained on therapy for 1 year. Nineteen women suffered an additional fracture. Compared to women without a prior fracture, women with at least 1 fracture prior to admission were more likely to have osteoporosis diagnosed and to receive osteoporosis-related medications.


CONCLUSIONS
Despite guidelines that recommend osteoporosis evaluation in adults experiencing a low-trauma fracture, we report that postmenopausal women hospitalized for low-impact fracture were not sufficiently evaluated or treated for osteoporosis during or after their hospital stay. There are substantial opportunities for improvement of care in this high-risk population to prevent subsequent fractures.
Simonelli
Christine
C
Department of Internal Medicine, Osteoporosis Services, HealthEast Clinics, Woodbury, Minn 55125, USA. msciao@attbi.com
Chen
Ya-Ting
YT
Morancey
Julie
J
Lewis
Anne F
AF
Abbott
Thomas A
TA
D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000601:surgery; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D008910:Minnesota; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D010818:Practice Patterns, Physicians'