Background Physicians can recognise and treat osteoporosis before the occurrence of fracture. Unfortunately, there is ample evidence that clinicians have not heard or heeded the message that condition is treatable, and that selected patients, particularly those who have already suffered a fracture, should be counselled to received preventive therapy.1 Epidemiologic studies have demonstrated that a history of osteoporotic fracture places a patient at very high risk of future fractures.2
Objectives The purpose of this study was to investigate whether elderly patients admitted to our hospital with a principal diagnosis of hip fracture had a prior diagnosis of osteoporosis or a previous osteoporotic fracture and their previous prescribed treatment.
Methods We performed a prospective chart review of all elderly (> = 65 years) patients admitted with the diagnosis of acute hip fracture in a public hospital in Barcelona, Spain, from January 1, 1999, to December 31, 2000. Data were collected by interviewing each patient immediately after their fracture with a structured questionnaire including patient age, sex, residence, the number, type and causes of fractures, as well as previous history of osteoporosis or osteoporotic fracture, and previous treatment for osteoporosis.
Results A total of 741 patients were included. Mean age was 81.54 (range 65–103) and 74.14% were women. Six hundred seven (81.91%) patients were admitted from their own home. Thirty (4.05%) patients had other associated fracture; the most common was a subcapital humeral fracture, which occurred in 13 patients. There were 447 (60.32%) extracapsular fractures. A fall was the most common cause of hip fracture (94.87% of cases). A prior diagnosis of osteoporosis was recorded in 50 (6.74%) patients; of them 23 (46%) were using calcium, vitamin D, alendronate or calcitonin. A history of hip, vertebral, wrist or another osteoporotic fracture, was recorded in 221 (29.82%) patients but only 18 (8.14%) were using any treatment for osteoporosis. Moreover 66 patients (8.91%) had suffered from more than one fracture. Forty-seven patients (6.34%) were on long term systemic steroids treatment for 6 months or more; ten (21,28%) were treated with calcium, vitamin D, alendronate or calcitonin. Eight patients admitted with a hip fracture in 1999 had a second hip fracture in 2000, but only two were receiving preventive therapy.
Conclusion Rates of utilisation of pharmacological treatment for osteoporosis were low. Prior diagnosis of osteoporosis was the condition that implied a better (less than half) preventive treatment, but clinicians dis not consistently initiate treatment for skeletal fragility after one or more fractures had occurred.
Bauer DC. Osteoporotic fractures: ignorance is bliss?. Am J Med. 2000;109:338–9
Cummings SR, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995;332:767–73