Category: Calcium/Bone Disorders
Assess sub optimal investigation and treatment initiation for osteoporosis despite presence of multiple risk factors
Methods : Retrospective analysis
Acute orthogeriatrics service of John Hunter Hospital provided service for 187 patients with neck of femur fracture (NOFF) during January 2017 to June 2017. Patients average age 82.3 years, 64.2% were female, 0.5% aboriginal, 23.5% were from residential aged care facility, 42.2% were not requiring any walking aids, and 41.2% were with diagnosed cognitive impairment. On presentation, 54% patients were not on any bone protective agents, 32.6% were on calcium and or vitamin D supplementation and 13.4% on bisphosphonate or another potent bone modifying agent. During discharge this numbers changed to 7.5%, 43.3% and 43.3% respectively (5.9% not recorded). Overall, 53.5% patients had at least one common metabolic condition (20.8% diabetes, 23% with deranged liver functions, 24% with Chronic Kidney Disease, 5.9% with hyperparathyroidism, 2.1% with hyperthyroidism). 58.8% patients were on at least 1 or more medications having large to modest risk of osteoporosis. 58.8% had 1 or more other metabolic conditions (15.5% hyponatremia, 8% hypomagnesemia, 6.4% hypothyroidism and 38.5% dyslipidaemia) that possibly also contributes to osteoporosis. 41.7% patients did not have weight records, however 16% of the recorded weighed <60 kg. Despite presence of significant risk factors, only 23% patients had pre event (before NOFF presentation) Bone Mineral Density (BMD/DEXA scan), even after a fragility fracture (post NOFF admission) only 16% patients had a BMD scan done over one year after discharge from hospital since admission with fragility fracture.
To compare and contrast driving decisions to perform BMD (DEXA scan), patients who had pre NOFF BMD, were more cognitively intact (72.1% with normal cognition in pre event BMD available group vs 54.9% in no pre event BMD available group), were more likely from private residence (81.4% from private residence in pre event BMD available group vs 75% in no pre event BMD available group), were less dependent on walking aid (51.2% required walking aid in pre event BMD available group vs 60% in no pre event BMD available group). Patients who had post event BMD, were younger (average age 71 years), almost all (96.7%) from private residence, about two thirds (63.3%) were not using walking aid and 83.3% were with normal cognition.
These findings suggest under diagnosis of osteoporosis in the community and underpins sub optimal investigation and treatment initiation in these population for osteoporosis despite presence of multiple risk factors for osteoporosis.
Mahbub Hasan– Advanced Trainee, Royal Australian College of Physicians, Hornsby, New South Wales, Australia