Are Traumatologists Treating Osteoporosis to Prevent New Fractures in Brazil?

Abstract

Objectives:To determine the proportion of traumatologists who investigate osteoporosis in elderly patients with fractures and recommend secondary prevention of osteoporotic fractures.Methods:We distributed questionnaires to 244 physicians attending the 2015 Brazilian Congress of Orthopedic Trauma. We determined the respondents’ profiles and assessed how they investigated and treated osteoporosis in elderly patients with fractures.Results:Overall, 32% of the respondents reported that their knowledge level regarding osteoporosis ranged from 0-5 (out of 0-10). In total, 42% of the participants reported that they usually requested DXA for elderly patients with fractures and less than 30% reported prescribing supplemental calcium and/or vitamin D. We considered physicians conducting a complete treatment for the patient as those who in addition to requesting DXA prescribed supplemental calcium, vitamin D, and specific medications for their elderly patients, and recommended non-pharmacological measures. Only 0.8% of the participants fulfilled all these criteria. In addition, 47% of the traumatologists reported that they did not treat osteoporosis directly but instead, referred osteoporotic patients to a qualified physician.Conclusion:Less than 50% of the surveyed traumatologists investigated and performed secondary prevention against osteoporotic fractures after treating an elderly patient with a fracture. Level of evidence III, Economic and Decision Analyses - Developing an Economic or Decisions Model.

Do Older Patients “Warn” That They Will Suffer a New Fracture?

“…These findings are worrisome and demonstrate that the treatment of osteoporosis in patients after fracture, despite the numerous publications warning about the subject in the literature, remains less than ideal. ( 5 ),( 7 ),( 10 ),( 12 ),( 13 ),( 17 …”

“…( 2 ),( 5 ), ( 6 ), ( 7 ), ( 8 ), ( 9 ), ( 10 However, the lack of diagnostic accuracy and guidance of appropriate osteoporosis treatment remain high, even in patients who have already had a first osteoporotic fracture. ( 5 ),( 7 ),( 10 ), ( 11 ), ( 12 ), ( 13 …”

Avaliação dos fatores de risco para osteoporose e aplicação da ferramenta FRAX clínico em idoso

“…Neste presente estudo, dos 31 pacientes diagnosticados com osteoporose, 19 faziam suplementação de cálcio e vitamina D, dois apenas de Cálcio, um apenas de Vitamina D, nenhum fazia tratamento farmacológico específico e nove não faziam suplementação e tratamento farmacológico específico. Isso demonstra que mais pacientes deveriam realizar o tratamento adequado da osteoporose com o intuito de evitar complicações graves, como novas fraturas e deformidades secundárias, dor crônica e perda da independência, conforme também observado em outros estudos 20 .…”

Fragility fracture systems, Latin America perspective

“…Despite the impact of osteoporosis and fragility fractures in Brazil, these authors highlighted that 80% of patients with fragility fractures are not evaluated or treated for osteoporosis or fall prevention to reduce secondary fractures. Of interest, Zamboni et al showed that less than 50% of orthopedic surgeons regularly investigated and performed secondary prevention against osteoporotic fractures after treating an elderly patient with a fracture [45] . Finally, Brazil's Ministry of Health expenditures on drugs to treat osteoporosis represent approximately 10.9% of the overall total spending on high-cost medications [46] …”

“…Of interest, Zamboni et al showed that less than 50% of orthopedic surgeons regularly investigated and performed secondary prevention against osteoporotic fractures after treating an elderly patient with a fracture. [45] Finally, Brazil's Ministry of Health expenditures on drugs to treat osteoporosis represent approximately 10.9% of the overall total spending on high-cost medications. [46] …”