Missing a therapeutic window of opportunity: An audit of patients attending a tertiary teaching hospital with potentially osteoporotic hip and wrist fractures

Objective. To establish the rate of and the predictors for performance of a bone mineral density (BMD) test and the treatment of osteoporosis in an at -risk cohort of patients attending a tertiary teaching hospital with fractu re possibly related to osteoporosis. Methods. A list of all patients between ages 40 and 85 who had been admitte d to a tertiary teaching hospital in the last 18 mo with hip fracture or se en in the accident and emergency department with a wrist fracture over the last 30 mo was obtained from computer records; those patients were invited to participate in the audit. In a followup telephone questionnaire, they we re queried about potential risk factors for osteoporosis and subsequent fra cture, the performance of a BMD test, any information received on osteoporo sis and the source of this information, and the prescription of any treatme nt for osteoporosis. Results. In total, 218 patients were included in the audit from a potential 374 eligible patients. The majority were female (78%), with hip and wrist fractures in 42% and 58%, respectively; 32% subsequently had BMD measured a nd 39% were offered treatment for osteoporosis. Ninety-four percent of pati ents had heard of osteoporosis, with the major source of information being the media (83%) and friends (23%), with little information from the medical profession (34%). The major predictors for a patient to have a subsequent BMD test were female sex (OR 3.4. 95% CI 1.3-9.9), history of a previous fr acture after the age of 50 (OR 2.3, 95% CI 1.0-5.6), family history of oste oporosis (OR 3.5, 95% CI 1.3-9.5), or the use of concurrent medications wit h a potential to cause osteoporosis (OR 2.5, 95% CI 1.1-5.8). The main pred ictors of treatment for osteoporosis being offered were age (risk increased by 1.04 for every year of life), abnormal result on the BMD test (OR 19, 9 5% CI 6-60), history of fracture after the age of 50 (OR 2.6, 95% CI 1.1-6. 7), and a history of fracture with minimal trauma (OR 2.6. 95% CI 1.1-4.2). There was a range of treatments offered, with calcium supplementation alon e accounting for 60% of treatments. Conclusion. Osteoporosis was overlooked by medical practitioners responsibl e for the care of this at-risk patient cohort, with little evidence of the medical profession offering information, further investigation, or treatmen t of patients who presented with a probable osteoporotic fracture of the hi p or wrist. This suggests that greater education of the accident and emerge ncy and orthopedic medical staff as well as the general public is required concerning this opportunity to investigate and treat symptomatic osteoporos is.