Preventing fragility hip fracture in high risk groups: an opportunity missed

Objective: The national guideline recommends selective case finding as the main strategy by identification of high risk people. This study assessed whether high risk patients were identified before their presentation with fragility fracture. Methods: A prospective study for 3.5 consecutive months on...

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Bibliographic Details
Published in:Postgraduate medical journal 2006-08, Vol.82 (970), p.528-531
Main Authors: Peng, E W K, Elnikety, S, Hatrick, N C
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Disease prevention
Female
Fractures
Fractures, Spontaneous - prevention & control
fragility fracture
General aspects
Hip Fractures - prevention & control
Hip joint
Hospitals
Humans
Hyperthyroidism
Liver diseases
Male
Medical sciences
Middle Aged
Original
Osteoporosis
Osteoporosis - prevention & control
Patients
prevention
Prospective Studies
Risk Assessment
Risk Factors
Steroids
Vitamin D
Womens health
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Summary:Objective: The national guideline recommends selective case finding as the main strategy by identification of high risk people. This study assessed whether high risk patients were identified before their presentation with fragility fracture. Methods: A prospective study for 3.5 consecutive months on patients with low energy hip fractures to Brighton and Sussex University Hospital NHS Trusts, which serves a population of 460 000. Data were collected by interview using standardised form, medical record review, and communication with family physicians. Definition of high risk: (1) untreated hypogonadism (2) corticosteroid users (3) disorders with increased bone loss (4) previous fragility fractures. Results: 98 patients were admitted with hip fracture. Thirty nine (40%) had at least one high risk factor. High risk patients (7 of 39, 18%) were no more likely to receive prophylaxis compared with patients without high risk factor (5 of 59, 8%) (p = 0.21). Previous fragility fracture (23) was the commonest risk factor followed by disorders with increased bone loss (10), premature menopause (10), and corticosteroid users (5). Fifteen patients (15%) had susceptibility to frequent falls and two had maternal history of osteoporosis. The proportion of treated patients were 20% (2 of 10) in premature menopause, 10% (1 of 10) in diseases with secondary osteoporosis, 13% (3 of 23) in previous fragility fracture, and 80% (4 of 5) in corticosteroid users (p = 0.01) Conclusion: Prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.
ISSN:0032-5473
1469-0756
DOI:10.1136/pgmj.2005.044370