Secondary fracture prevention measures in orthopedic wards in Belgium

Abstract

Objective: In-hospital diagnosis of osteoporosis in fracture patients in the orthopedic wards is lower than 10% and the prescription rate of treatments is less than 5%. The present report decribes the efficiency of a secondary prevention program in Fracture patients in Orthopedic Wards (FORWARD) in a Belgian hospital care setting. Materials and methods: Orthopedic surgeons willing to participate in the program were requested to refer their patients with clinical fractures for bone densitometry and an osteoporosis specialist's advice. Results: In 36 hospitals data were collected about 4.116 fracture patients. Females represented 73.5% of the population. fracture prevalence increased until the age of 80-85 years, with mean age of 78 year in women and 74 year in men. Most of the fracture cases were hospitalized (88%) and the main fracture type included in the program was hip fracture (45%). Previous clinical fractures were reported in 21% of the patients. Nine percent had previous DXA examination of concomitant osteoporosis treatments and were therefore excluded from DXA referral. Appointments for DXA examination were made in 66% (n=2,718) of the patients and results were obtained from 53% (n=2,181). The diagnostic classification was as follows: osteoporosis 56%, osteopenia 33% and normal bone density 11%. Nearly all cases were referred for diagnostic confirmation of the problem by an osteoporosis specialist, mainly rheumatologists and physiotherapists. Final clinical diagnosis of osteoporosis was accepted in 39% of the cases. Treatment with calcium and vitamin D was started in 1,303 patients (31%), with bisphosphonates in 888 patients (21%) and with SERMs or other drugs in 108 patients (<3%). No data about compliance to these treatments were obtained in the present project. Conclusion: The active referral by orthopedic surgeons of the fracture patients in the orthopedic ward to DXA units and osteoporosis specialists results in the identification of osteoporosis in 39% of the patients. Implementing effective measures and treatments for (secondary) fracture prevention in this high risk population could lead to cost-savings in the short term. Initiatives to promote the patient flow needs to b elaborated and maintained by an active local care organisation.