Awareness of Osteoporosis and Compliance with Management Guidelines in Patients with Newly Diagnosed Low-Impact Fractures

Abstract

A pre-existing fracture is a strong predictor of additional osteoporotic fractures. Consequently, current guidelines emphasize the need for treating patients with existing osteoporotic fractures. The present study aimed to assess the implementation of osteoporosis guidelines in routine practice. To this end, we reviewed the hospital charts of women and men aged 50 years and older with new fractures due to low or moderate impact treated in the emergency room, orthopedic surgery and rehabilitation departments. Notation of osteoporosis as a contributing cause for the fracture, performance of screening laboratory tests for possible secondary causes and treatment recommendations were abstracted from the record. In addition, we utilized the centralized pharmacy and laboratory computerized databases of the largest health maintenance organization in the area to follow dispensation of osteoporosis drugs and performance of screening laboratory tests in the community following fracture incidents. During the corresponding periods of January and February 1998 and 1999, 183 patients aged 50 years and older with low-impact fractures were treated in the emergency room only and 113 were hospitalized. Osteoporosis was rarely mentioned in the medical documentation. During the 6 month period after the fracture incident at least 70% of the emergency room patients and 62% of the hospitalized patients received no osteoporosis drugs. However, an encouraging significant trend toward increasing use of osteoporosis drugs, both prior to and after a fracture incident, was noted between the two survey periods among the emergency room fracture patients, but not among the hospitalized patients. Calcium supplements were the most commonly used osteoporosis drug. Bisphosphonates, hormone replacement therapy, raloxifene and calcitonin were rarely prescribed. Men were less likely than women to receive treatment for osteoporosis. Systematic laboratory evaluations for secondary causes of osteoporosis were not performed. We conclude that despite extensive attempts at increasing awareness among health professionals and the public at large, osteoporosis is still rarely singled out as a problem in patients with newly diagnosed low-impact fractures, and the majority of them are not managed according to guidelines. Further studies should address specific problems in physicians' and patients' attitude that may account for the present situation.

Osteoporosis management among residents living in long-term care

“…Use of osteoporosis medications prior to fracture was not included as a predictor in the current study as not all residents included had had a fracture. An increased likelihood of osteoporosis management among females has been reported previously among community-living individuals with fragility fractures [14,[38][39][40][41][42][43], among home care recipients [15] and among LTC residents in the USA [20,21]. Although gender was not a predictor of treatment in the current study, previous studies reporting that osteoporosis tends to be overlooked in males suggest the need to initiate osteoporosis investigation in males as well as females to ensure that at-risk males receive adequate management.…”

Access to fracture risk assessment by FRAX and linked National Osteoporosis Guideline Group (NOGG) guidance in the UK—an analysis of anonymous website activity

“…There are many hurdles to overcome in optimising the use of guidance, ranging from awareness of its existence to implementation and impact on individual care. Low awareness will always result in low adherence but, even with detailed plans and processes for implementation, clinician knowledge of such guidelines is relatively low world-wide for osteoporosis [18][19][20][21] and other chronic diseases. Education is obviously important but its effectiveness can be disappointing; for example, a Cochrane review reported that continuing medical development meetings led to only relatively small improvements in practice and patient outcomes [22].…”

Knowledge of orthopaedic surgeons in managing patients with fragility fracture

“…Therefore, it seems that orthopaedic surgeons have a unique opportunity and major responsibility in managing osteoporosis in a patient with a fragility fracture. However, it has been found [13,[20][21][22][23][24] that many orthopaedic surgeons still neglect to detect, assess and treat such patients for osteoporosis.…”