Secondary screening for osteoporosis in patients admitted with minimal-trauma fracture to a major teaching hospital.

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 < or =-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.