title: When continuity of care breaks down: a systems failure in identification of osteoporosis risk in older patients treated for minimal trauma fractures.
abstract: OBJECTIVE
  Minimal trauma fractures may be the first indication of osteoporosis. Our aim was to determine the proportion of patients who underwent bone density testing for osteoporosis of those with a minimal trauma wrist fracture treated in the emergency department (ED).
  
  
  METHODS
  This observational retrospective cohort study used explicit medical record review and scripted telephone interviews.
  
  
  METHODS
  EDs of three metropolitan hospitals in Melbourne in 2006.
  
  
  METHODS
  Patients aged 50 years and over who were treated for wrist fracture due to minimal trauma. Data collected included demographic details, fracture details, causes of injury, any bone density testing and any osteoporosis-related medication change.
  
  
  METHODS
  The proportion of patients who underwent bone density testing in the follow-up period.
  
  
  RESULTS
  131 patients were studied; 83% were female, and the median age was 71 years. No patient was referred by an ED or fracture clinic for bone density testing (95% CI, 0-3.5%). Telephone follow-up data were obtained from 91 patients. Of these, 28 reported having bone density testing after their fracture, of whom 14 (50%; 95% CI, 32%-67%) were found to have osteoporosis. Seven were treated with a bisphosphonate and one with a selective oestrogen-receptor modulator.
  
  
  CONCLUSIONS
  Follow-up of patients suffering minimal trauma wrist fractures treated in the ED is poor. Systems to improve the identification and treatment of osteoporosis in this group are needed if future osteoporotic fractures and their consequences are to be avoided.
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, VIC. Anne-Maree.Kelly@wh.org.au
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Kelly
authors.forename: Megan
authors.initials: M
authors.lastname: Clooney
authors.forename: Debra
authors.initials: D
authors.lastname: Kerr
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D004164:Diphosphonates / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D014954:Wrist Injuries / Q000209:etiology* / Q000628:therapy
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates