An audit of current clinical practice in the management of osteoporosis inNottingham

Background Osteoporosis is now recognized by the World Health Organization and the Department of Health as a major public health problem. In 1994, the Advisory Group on Osteoporosis (AGO), set up by the Department of Health, recommended that Health Authorities and general practitioner fundholders sh ould purchase bone densitometry services for the management of osteoporosis . The aims of this study were to assess the criteria for requests for bone densitometry from primary care in comparison with the AGO recommendations a nd to compare the numbers of patients referred with a low-trauma osteoporot ic fracture with the expected number of fractures in the Nottingham area. Methods Patient referral data and requests for bone densitometry were colle cted by case note review of all new patients referred to the Nottingham Ost eoporosis Clinic over a 12 month period and then compared with the AGO reco mmendations. The patients referred with a history of a low-trauma fracture were then compared with the expected incidence of fractures, calculated usi ng age-sex-specific fracture incidence data applied to the Nottingham popul ation Census statistics. Results A total of 413 patients were referred to the Osteoporosis Clinic fo r bone densitometry. Almost two-thirds of the patients had no clinical indi cators for requests for scanning, in comparison with the AGO recommendation s. Seventy-seven patients were referred with vertebral fracture, 12 hip, 20 colles and 26 other fractures. Using age-sex-specific fracture incidence d ata applied to the Nottingham population Census statistics, it was estimate d that the expected incidence of hip fractures would be 812, distal forearm fractures 514 and vertebral fractures presenting to clinical attention 625 . This represents 1.5 per cent of the total hip fractures, 3.9 per cent dis tal forearm and 12.3 per cent vertebral actually presenting to the Osteopor osis Clinic. Conclusion Bone densitometry was requested in up to 60 per cent of the pati ents with no clinical risk factors to warrant bone densitometry. Osteoporos is-related fractures remain unrecognized in clinical practice. The majority of patients do not receive specialist assessment despite being at high ris k of future fracture. Further steps are necessary to educate health care pr ofessionals in primary and secondary care, but more importantly, to direct services more proactively in those at high risk of future fracture.