Osteoporotic fracture: missed opportunity for intervention

As prior fracture is consistently associated with increased risk of subsequent fracture, subjects with a history of prior fracture represent a high risk group which should be targeted for intervention to reduce future fracture rates. The aim of this study was to investigate whether prior osteoporotic fracture affected treatment patterns among subjects admitted with hip fractures. All hip fracture admissions to two major teaching hospitals of the University of New South Wales, Sydney, Australia, over the 12-month period between July 1997 and June 1998 were identified retrospectively from medical records. Patient demographics, frequency and location of prior fractures, and treatment status on admission were recorded. There were a total of 348 atraumatic hip fracture admissions over this 12-month period. Forty five percent of 251 women and 30% of 97 men with an osteoporotic hip fracture had a known prior fracture, including prior hip fracture in 19% of the women and 8% of the men. Among subjects with prior fractures, only18% of women and 7% of men were on any specific anti-osteoporosis therapy. Even among those with a prior hip fracture, only 21% of women and none of the men were taking optimal appropriate therapy. A high proportion of individuals suffering hip fractures had sustained prior 'signal' fractures. Although more subjects with prior fracture received treatment than those without prior fracture, total treatment levels were low, and the majority of high-risk subjects did not receive therapy shown to reduce the risk of further fractures.