Redman Ishtar A, Sivanesan Vicnesan
General Practice, Ealing Hospital, London North West University Healthcare NHS Trust, London, GBR.
General Practice, The Mansell Road Practice, London, GBR.
Cureus. 2023 Sep 19;15(9):e45532. doi: 10.7759/cureus.45532. eCollection 2023 Sep.
Background Fragility fractures typically occur in the elderly population due to low-energy trauma in the context of underlying osteoporotic bone disease. These fractures are becoming increasingly more common as the population of the United Kingdom ages, representing a significant public health issue. In the community, a joint care approach is adopted between general practitioners and fracture liaison services for the management of patients with fragility fractures. Despite this, preventive care for these patients remains substandard. This project aimed to conduct an audit of patients with a coded diagnosis of a fragility fracture in our primary care practice to ascertain fracture type and the prescription of bone protective agents. When necessary, the appropriate therapy was commenced per best practice guidelines. Methodology A search of patients with the diagnosis of on our electronic patient database, SystmOne, was conducted for the period of April 2019 to April 2023 inclusive. A retrospective audit of electronic patient records was done to identify patient demographic data, fracture types and dates, osteoporosis prescriptions, vitamin D/calcium supplementation, and bone densitometry scan results (dual-energy X-ray absorptiometry). Results A total of 47 patients were identified with a coded diagnosis of a , of whom 36 were females and 11 were males. The average age of the patients was 76.89 years with a range of 50 to 97. In total, 49 fractures were identified. More than two-thirds of the fractures identified were either distal forearm or neck of femur fractures (18 and 15, respectively). Of the 47 patients identified, 33 were on bone protection agents. Further, 26 received both bisphosphonates and calcium/vitamin D supplementation. Seven patients were on bisphosphonate monotherapy, and the remaining two patients were on vitamin D/calcium supplementation alone. Of the 47 patients, 12 had neither form of therapy prescribed. Conclusions Despite the joint effort between fracture liaison services and general practitioners, the secondary prevention of fragility fractures within the community remains inadequate. Fragility fractures are associated with significant morbidity, mortality, and re-fracture rates and incur significant costs to the National Health Service. Local practitioners must routinely evaluate their data to identify opportunities to improve patient care. Effective and timely treatment could be key to the prevention of new or second fractures.
背景 脆性骨折通常发生在老年人群中，是由于潜在骨质疏松性骨病背景下的低能量创伤所致。随着英国人口老龄化，这些骨折越来越常见，成为一个重大的公共卫生问题。在社区中，全科医生和骨折联络服务机构采用联合护理方法来管理脆性骨折患者。尽管如此，对这些患者的预防性护理仍未达标准。本项目旨在对我们基层医疗实践中编码诊断为脆性骨折的患者进行审核，以确定骨折类型和骨保护剂的处方情况。必要时，根据最佳实践指南开始适当的治疗。方法 对我们的电子患者数据库SystmOne中2019年4月至2023年4月（含）期间诊断为[此处原文缺失具体诊断内容]的患者进行搜索。对电子患者记录进行回顾性审核，以确定患者人口统计学数据、骨折类型和日期、骨质疏松症处方、维生素D/钙补充剂以及骨密度扫描结果（双能X线吸收法）。结果 共识别出47例编码诊断为[此处原文缺失具体诊断内容]的患者，其中36例为女性，11例为男性。患者的平均年龄为76.89岁，范围为50至97岁。总共识别出49处骨折。识别出的骨折中超过三分之二为前臂远端或股骨颈骨折（分别为18处和15处）。在识别出的47例患者中，33例正在使用骨保护剂。此外，26例同时接受双膦酸盐和钙/维生素D补充剂治疗。7例患者接受双膦酸盐单药治疗，其余2例患者仅接受维生素D/钙补充剂治疗。在47例患者中，12例未开具任何一种治疗药物。结论 尽管骨折联络服务机构和全科医生共同努力，但社区内脆性骨折的二级预防仍然不足。脆性骨折与显著的发病率、死亡率和再骨折率相关，并给国民医疗服务体系带来巨大成本。当地从业者必须定期评估他们的数据，以确定改善患者护理的机会。有效且及时的治疗可能是预防新骨折或二次骨折的关键。
