64OSTEOPOROSIS MANAGEMENT FALLING THROUGH THE CRACKS

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Abstract

Introduction: Fractures associated with the presentation of falls to hospitals offer an opportunity for the treatment of osteoporosis in older adults. This group of patients is at a high risk of recurrent fractures [(Kaniset al. (2004, Bone, 35, 375–82)].

Methods: Retrospective analysis of those discharged with a fracture following a fall from January to June 2011 was carried out. Data collected included demographics, investigations and medications.

Results: This study analysed 331 patients with fractures. There were 180 episodes of lower-extremity (LL) fracture, 92 of upper-extremity (UL), 11 combined and 48 other fracture. Age and length of stay were significantly greater for LL than UL fractures (82 versus 79 years P = 0.002; 12.1 versus 6.4 days P = 0.0001). The sex distribution was similar. A significantly greater proportion of those with LL fractures had further investigation with electrolytes (93.9 versus 73.9%; P = 0.000) including calcium (86.03 versus 63.04% P = 0.000). Those with LL fracture were more likely to be on comprehensive anti-osteoporotic medication (51.1 versus 26.7% P = 0.000). Only 50% of those requiring osteoporotic medication received the appropriate medication.

Conclusions: Post-fracture osteoporosis treatment is suboptimal in this group. The treatment of those with non-LL fractures is a key issue to address as they are typically more ambulant and at a higher risk of re-fracture. Multiple strategies including Fracture Liaison Service, case-based management and notification systems have assisted with closing this gap and these should be considered in our patient group [William et al. (2012, CMAJ, 184, 290–6); Cooper et al. (2012, Osteoporosis Int, 23, 97–107)].

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