Only 40 per cent of patients with a fragility fracture are
aware of their osteoporosis risk - a level that is likely to remain a barrier
to patients seeking medical review and managing their risk, according to
research published in the Medical Journal of Australia.
Dr Charles Inderjeeth, Geriatrician and Rheumatologist at
the North Metropolitan Area Health Service, Perth, and co-authors implemented
and evaluated a multimodal intervention to improve osteoporosis treatment in
patients discharged from an emergency department (ED) after presentation with a
Dr Inderjeeth said that, after implementation of the
intervention, the rate of bone mineral densitometry investigations improved
from three per cent to 45 per cent, the number of patients receiving calcium
and vitamin D supplementation increased from 12 per cent to 33 per cent and
from 12 per cent to 37 per cent, respectively, and initiation of specific
osteoporosis treatments increased from six per cent to 30 per cent.
But despite improvements in these outcome measures, Dr
Inderjeeth said that only a minority of patients were aware of osteoporosis,
although most GPs and hospital clinicians accepted that it was their
responsibility to assess and treat their patients and inform them of their
"The persistent low level of awareness of osteoporosis
remains a significant concern and is likely to remain a barrier to patients seeking
medical review and accepting and complying with preventive treatment," he said.
"Most ED and orthopaedic clinicians in our institution
claimed that time and resources were the main barriers to improving the quality
of osteoporosis care in their settings.
"It is possible that the ED may not be the best setting for
giving patients educational information about fracture prevention and
osteoporosis, given that they are preoccupied at the time with more acute
issues of pain, comorbidity and anxiety in an overwhelming environment."
Dr Inderjeeth said that 84 per cent of patients referred to
the Fragile Bone Clinic presented for osteoporosis review at the clinic after
being contacted by a fracture liaison nurse.
This suggests that a multimodal strategy involving a
dedicated fracture liaison nurse may offer the greatest potential for improving
education and patient follow-up and treatment.
The Medical Journal of Australia
publication of the Australian Medical Association.