Singh Sushmit, Patil Shireen, Thein Myat, Kulkarni Jigisha, Kakroo Azra Z, Singh Ladlee, Dhotare Bhagyashree, Nolan Elizabeth
Orthopaedics, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, GBR.
Medicine, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, GBR.
Cureus. 2024 Dec 19;16(12):e76047. doi: 10.7759/cureus.76047. eCollection 2024 Dec.
Background Fragility fractures, often caused by osteoporosis, are a major public health concern among the growing population of the United Kingdom (UK). In addition to being a major source of illness and mortality, the rising incidence of osteoporosis places a heavy strain on healthcare systems if it is not adequately managed. In order to lower the risk of additional fractures, current guidelines place a strong emphasis on the timely evaluation and treatment of fragility fractures. Methods This retrospective audit was carried out in Warrington Hospital, UK, to examine the management of fragility fractures in patients aged 65 years and above across two cycles (January to March 2022 and April to May 2023, respectively). All data was obtained from electronic medical records, and management was assessed, including treatment with bisphosphonates, vitamin D, dual-energy X-ray absorptiometry (DEXA) scans and further referrals for metabolic bone clinics. Results The first cycle included 144 inpatients and showed significant under-utilization with only 16% receiving bisphosphonates treatment (23 inpatient prescriptions), low referrals for DEXA scan and metabolic bone clinics. Assessment and supplementation of vitamin D was also suboptimal. The second cycle of the audit reviewed 165 patients and showed minor improvement in bisphosphonates prescription, although post-discharge rates were low with around 80% of patients (104 of 131, as 34 patients were prescribed while inpatient) not receiving medications. The DEXA scans and metabolic bone clinic referrals also remained inadequate in the second cycle. Conclusions This audit highlighted the significant gap in the management of fragility fractures and persistent deficiencies in spite of robust guidelines and interventions set by various bodies. The implementation of treatment guidelines for osteoporotic patients at hospital level can help in timely initiation of antiresorptive therapy, DEXA scans and utilisation of metabolic bone clinics to optimise outcomes and reduce the burden on healthcare systems. There is a need for further research and education to improve this adherence to set guidelines and improve outcomes.
脆性骨折通常由骨质疏松症引起，是英国不断增长的人口中一个主要的公共卫生问题。骨质疏松症不仅是疾病和死亡的主要原因，而且如果管理不当，其发病率的上升会给医疗系统带来沉重负担。为了降低再次骨折的风险，当前指南高度强调对脆性骨折进行及时评估和治疗。
这项回顾性审计在英国沃灵顿医院进行，以检查65岁及以上患者在两个周期（分别为2022年1月至3月和2023年4月至5月）内脆性骨折的管理情况。所有数据均从电子病历中获取，并对管理情况进行评估，包括双膦酸盐治疗、维生素D治疗、双能X线吸收法（DEXA）扫描以及转介至代谢性骨病门诊进一步诊治。
第一个周期包括144名住院患者，结果显示存在明显的使用不足情况，只有16%的患者接受了双膦酸盐治疗（23份住院处方），DEXA扫描和转介至代谢性骨病门诊的比例较低。维生素D的评估和补充情况也不理想。审计的第二个周期对165名患者进行了审查，结果显示双膦酸盐处方略有改善，尽管出院后的用药率较低，约80%的患者（131名患者中的104名，因为有34名患者在住院期间已开具处方）未接受药物治疗。第二个周期中，DEXA扫描和转介至代谢性骨病门诊的情况仍然不足。
这项审计突出了脆性骨折管理方面的重大差距，尽管各机构制定了强有力的指南和干预措施，但仍存在持续不足。在医院层面实施骨质疏松症患者治疗指南有助于及时启动抗吸收治疗、进行DEXA扫描以及利用代谢性骨病门诊，以优化治疗效果并减轻医疗系统的负担。需要进一步的研究和教育来提高对既定指南的遵守情况并改善治疗效果。
