Secondary fracture prevention measures in orthopedic wards in Belgium

Abstract

Objective: The FORWARD project intended to improve osteoporosis care in Fracture patients in Orthopedic WARDs (FORWARD) in the Belgian hospital care setting. Methods: Orthopedic surgeons willing to participate in the program were requested to actively refer their patients with clinical fractures for bone densitometry and an osteoporosis specialist's advice. Data collection was done by a short easy to complete summary questionnaire. Results: Data from 7758 fracture patients were collected. In hospital patients and females represented respectively 84% and 75% of the cases. Fracture prevalence in the study population peaked at the age of 75 to 85 years both in men and women, respectively 35% and 42%. The main fracture type were hip (45%), other (25%), spine (9%), wrist (8%), pelvis (7%) and humerus (7%). Previous clinical fractures were reported in 22% of the patients. Appointments for DXA examination were made in 66% (n = 5112) of the patients and results were obtained from 55% (n = 4274). The WHO diagnostic classification was as follows: osteoporosis 56%, osteopenia 33% and normal bone density 11%. 3855 patients were referred for diagnostic confirmation of the problem by an osteoporosis specialist. Final clinical diagnosis of osteoporosis was accepted in 2150 cases (27% of all patients and 42% of DXA referrals). Treatment with calcium and vitamin D was started in 2510 patients (32%) and with bisphosphonates in 1717 patients (22%). No data about compliance to these treatments were obtained in the present project. Conclusion: The FORWARD referral program for fracture patients in orthopedic wards for DXA investigation and osteoporosis specialists' advice resulted in the identification of osteoporosis in 27% of all fracture 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 be elaborated and maintained by an active local care organisation.