title: Secondary prevention of osteoporosis following fragility fractures of the distal radius in a large health maintenance organization.
abstract: A retrospective study evaluated a large health maintenance organization for secondary prevention of osteoporosis following fragility fractures of the distal radius. Our population remained undiagnosed and untreated despite the ability of the system to provide adequate care. These patients specifically should be targeted for a comprehensive multidisciplinary effort at prevention.
  
  
  OBJECTIVE
  Osteoporotic wrist fractures carry a high risk for subsequent fragility fractures. Despite therapeutic options and systems that can provide secondary prevention, patients are not always treated appropriately. Our purpose was to evaluate the treatment afforded following a distal radius fragility fracture in our health system.
  
  
  METHODS
  A retrospective review of fractures following surgery was performed. Radiographs and mechanism of injury defined fragility fractures. Demographic data, other fractures, and secondary prevention measures were documented.
  
  
  RESULTS
  Eighty-two patients were evaluated. The average age was 64 (10.2) years. The follow-up period following the index fracture was 25.2 months (SD = 4.6). Twenty-eight percent of patients had a second fragility fracture. Seven sustained a subsequent fracture within the follow-up period (8.5 %), and 16 (19.5 %) fractured prior to the index fracture. Mean time from primary to index fracture was 50 (42) months. Forty-seven percent of patients with an additional fracture carried the chart diagnosis of osteoporosis or osteopenia while 24.6 % of patients without an additional fracture carried this diagnosis (p = 0.049). No patients were referred for prevention or an endocrinologist at discharge. Twenty-one percent of patients were treated for osteoporosis at any point.
  
  
  CONCLUSIONS
  Patients were unlikely to receive appropriate evaluation and treatment for secondary prevention of fragility fractures in our system. A system-based treatment plan for the prevention of osteoporosis should be implemented. Since distal radius fractures occur early in osteoporosis, these fractures should be targeted for secondary prevention.
authors.affiliation: Lin Medical Center, Kupat Holim Clalit, Haifa, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Benzvi
authors.affiliation: Lin Medical Center, Kupat Holim Clalit, Haifa, Israel.|Technion Israel Institute of Technology School of Medicine, Haifa, Israel.
authors.forename: Adam
authors.initials: A
authors.lastname: Gershon
authors.affiliation: Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel.
authors.forename: Idit
authors.initials: I
authors.lastname: Lavi
authors.affiliation: Lin Medical Center, Kupat Holim Clalit, Haifa, Israel. ronitwollstein@gmail.com.|Technion Israel Institute of Technology School of Medicine, Haifa, Israel. ronitwollstein@gmail.com.|Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. ronitwollstein@gmail.com.
authors.forename: Ronit
authors.initials: R
authors.lastname: Wollstein
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors
chemical_list: D050071:Bone Density Conservation Agents
keywords: Distal radius; Fracture; Fragility; Osteoporosis; Prevention; Secondary