Funding: This study was partially supported by an unrestricted research grant from Aventis-Pharma.
Secondary screening for osteoporosis in patients admitted with minimal-trauma fracture to a major teaching hospital
Article first published online: 31 OCT 2003
Internal Medicine Journal
Volume 33, Issue 11, pages 505–510, November 2003
How to Cite
Wong, P. K. K., Spencer, D. G., McElduff, P., Manolios, N., Larcos, G. and Howe, G. B. (2003), Secondary screening for osteoporosis in patients admitted with minimal-trauma fracture to a major teaching hospital. Internal Medicine Journal, 33: 505–510. doi: 10.1046/j.1445-5994.2003.00468.x
Conflicts of interest: None
- Issue published online: 31 OCT 2003
- Article first published online: 31 OCT 2003
- Received 12 June 2002;accepted 27 September 2002.
- secondary screening;
- hormonal abnormality;
- vitamin D
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)