Background: A gap in care exists worldwide in secondary fracture prevention, with previous reports documenting only ten per cent of patients with minimal-trauma trauma fractures receiving appropriate investigation for osteoporosis. The aim of this study is to examine current fracture prevention practices at a large tertiary hospital in Victoria without a fracture liaison service.
Methods: A retrospective audit was conducted at Peninsula Health. 80 cases of minimal-trauma fracture in patients over the age of 50 presenting to the Frankston Hospital emergency department in December 2016 were identified using diagnosis-related group fracture codes and medical record review. Patient demographics, fracture type, length of hospital stay, previous diagnosis and treatment of osteoporosis, assessment of fracture risk factors, and osteoporosis investigation, treatment and follow up were entered into an Excel database.
Results: 60 females and 20 males aged 52 to 96 (median 80.5) years, with hip (30%), wrist (12.5%), ankle (12.5%), pelvis (8.8%), spine (8.8%), and other (27.5%) fractures were identified, of whom 18.8% had a prior diagnosis of osteoporosis. Median [range] length of stay was 13 [1-54] days. Prior treatment with calcium +/- vitamin D, bisphosphonates and denosumab were documented in 22.5%, 8.7% and 2.5% of patients respectively. 58.8% had appropriate investigations for osteoporosis; 22.5% were commenced on vitamin D, 8% calcium, 2.5% bisphosphonates and 10% denosumab. 11.3% were recommended for a bone density scan.
Conclusion: Over half of patients presenting to Frankston Hospital with a minimal-trauma fracture were investigated for secondary causes of osteoporosis and one quarter were commenced on treatment. Although this is a marked improvement from previous studies, further improvement is crucial for reducing the fracture burden. This may form the basis for introducing a fracture liaison service to the hospital.