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Keywords:

  • osteoporosis;
  • fracture;
  • secondary ­screening;
  • hormonal abnormality;
  • vitamin D

Abstract

Aims:  The aim of the present study was to determine: (i) the prevalence of the investigation and treatment of osteoporosis in patients admitted to hospital with a minimal-trauma fracture, (ii) the prevalence of osteo­porosis using bone mineral density assessment by dual X-ray absorptiometry (DEXA) in such patients and (iii) a clinical pathway for the management of osteo­porosis in such patients.

Methods:  A cross-sectional study was undertaken involving all patients admitted with a fracture to Westmead Hospital, Sydney, Australia, between January 1999 and June 2000 (n = 327). Of these, 264 were excluded because of: (i) the fracture following significant trauma (n = 83), (ii) unavailability of medical records for review (n = 38), (iii) nursing home status (n = 37), (iv) previous malignancy (n = 18), (v) deceased (n = 11), (vi) recent osteoporosis screening and/or treatment (n = 18), (vii) refusal to participate (n = 37), (viii) uncontactable (n = 16) and (ix) inadequate English (n = 6). The remaining 63 patients underwent DEXA assessment and the following laboratory investigations: (i) liver function tests, (ii) urea, (iii) electrolytes, (iv) calcium, (v) phosphate, (vi) full blood count, (v) 25-hydroxyvitamin D level and (vi) thyroid-function tests. In men, levels of serum free testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin were also obtained.

Results:  Of the 63 study participants, 87% of the 47 women were either osteoporotic (T <−2.5) or osteopenic (−2.5 <T <−1) at a mean of 12.7 ± 5.4 months post-fracture. Of the 16 men screened, 75% had a T-score ≤−1. Forty-four per cent of the study sample had a low 25-hydroxyvitamin D level, 6% were biochemically hyperthyroid and 40% of the men had a low serum free testosterone. Only 16% had an effective anti-­osteoporotic medication added following the fracture.

Conclusions:  Secondary screening and treatment of osteo­porosis in patients following minimal-trauma fracture are low. The implementation of a clinical pathway for osteoporosis management in these patients may be useful. (Intern Med J 2003; 33: 505−510)