Failure in diagnosis and under-treatment of osteoporosis in elderly patients with fragility fractures
We evaluated whether osteoporosis is adequately managed and treated in patients suffering from fragility fractures. Factors that influenced osteoporosis diagnosis and treatment rates were also assessed. To this end, patients with the principal diagnosis of low-energy hip, vertebral, or distal radius fractures were recruited for the study. Collected data included risk factors for osteoporosis, history of previous fractures, known history of osteoporosis, and osteoporosis treatment at the time of admission. The patients’ prefracture risk profile was also assessed to determine whether osteoporosis could have been identified prior to the index fracture. We identified 308 patients with fragility fractures, including 214 hip, 41 vertebral, and 53 distal radius fractures. Overall, 238 patients (77.3%) had at least one risk factor for osteoporosis. Eighty-eight patients (28.6%) had sustained ≥ 1 prior fragility fractures in the past. However, only 79 patients (25.6%) were aware that they had osteoporosis and even fewer (66 patients, 21.4%) had been receiving osteoporosis treatment preceding the current admission. Anti-osteoporotic agents were more commonly prescribed in patients 66–75 years old (p = 0.008), with a family history of osteoporosis (p = 0.009) or history of a prior fragility fracture (p = 0.012). The treatment rate was higher in women than men (p = 0.026) and in patients with vertebral or multiple prior fractures compared to patients with prior hip fractures. The current study provides evidence that individuals who experience fragility fractures are not adequately managed for osteoporosis. Only few of the historically known risk factors for osteoporosis were adequately recognized and associated with osteoporosis evaluation and treatment.
KeywordsFragility fracture Osteoporosis Osteoporosis risk assessment Anti-osteoporotic treatment
The authors would like to thank Dr. Antonios Koutalos for his invaluable assistance with patient interviews.
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
The study has been approved by the University’s institutional research board and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.
- 9.Bunta AD, Edwards BJ, Macaulay WB Jr, Jeray KJ, Tosi LL, Jones CB, Sietsema DL, Kaufman JD, Murphy SA, Song J, Goulet JA, Friedlaender GE, Swiontkowski MF, Dirschl DR (2016) Own the bone, a system-based intervention, improves osteoporosis care after fragility fractures. J Bone Jt Surg Am 98:e109CrossRefGoogle Scholar
- 10.World Health Organization (1998) Guidelines for preclinical evaluation and clinical trials in osteoporosis. http://apps.who.int/iris/handle/10665/42088. Accessed 28 Feb 2018
- 19.USPSTF (2016) Final Recommendation Statement. Vitamin D and calcium to prevent fractures: preventive medication. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/vitamin-d-and-calcium-to-prevent-fractures-preventive-medication. Accessed 18 Oct 2016
- 21.Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441CrossRefPubMedGoogle Scholar
- 22.Joffe HV (2013) Calcitonin salmon for the treatment of postmenopausal osteoporosis. Silver spring (MD): FDA; http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM343748.pdf. Accessed 21 Jan 2017
- 23.European Medicines Agency’s Committee for Medicinal Products for Human Use (2013) Recommendation to restrict the use of Protelos/Osseor (strontium ranelate).http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/04/news_detail_001774.jsp&mid=WC0b01ac058004d5c1. Accessed 5 Mar 2018
- 29.Ahmed LA, Center JR, Bjørnerem A, Bluic D, Joakimsen RM, Jørgensen L, Meyer HE, Nguyen ND, Nguyen TV, Omsland TK, Størmer J, Tell GS, van Geel TA, Eisman JA, Emaus N (2013) Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Tromsø study. J Bone Miner Res 28:2214–2221CrossRefPubMedGoogle Scholar