Secondary Prevention of Osteoporosis after Distal Radius Fragility Fractures

Objective: To evaluate the adequacy of existing treatment protocols for patients following surgery for fragility fractures of the distal radius in the CLALIT HMO in northern Israel.

Methods: Retrospective review of distal radius fragility fractures in a hand service between 2012-1013. Fragility fracture was defined by radiographs and mechanism- of- injury. Demographic data, previous and subsequent fractures, quality of secondary prevention were documented. Chi- square was used for analysis.

Results: Eighty-two patients were evaluated. Average age was 64 years. Follow-up post- index fracture was 25.2 months. Twenty-eight percent of the patients had a second fracture. Seven had a subsequent fracture within the follow- up period (8.5%), 16 had a fragility fracture prior to the index fracture. Mean time from primary to index fracture was 50 months. Patients who had additional fragility fractures were older, and had a diagnosis of osteopenia/osteoporosis. Hypercholesterolemia, hypertension and diabetes, did not seem to predispose to additional fractures.

No patients were referred for prevention or an endocrinologist at discharge. Forty –six percent of patients were treated at any point, most by the family physician with vitamin D and calcium. Sixteen patients with previous or additional fracture (76%) did not see an endocrinologist. Nine patients with a second fracture received no preventive medication. Twenty- two percent of the patients started some form of treatment after their index fracture.

Conclusion:

1) Our population behaves as an untreated population despite being part of a closed and organized medical system.

2) Patients were unlikely to receive appropriate evaluation and treatment for primary or secondary prevention of fragility fractures.

3) Secondary prevention is most important for patients with known osteopenia or osteoporosis, and patients above the age of 50.

4) A systems based treatment plan for the prevention of osteoporosis should be implemented, specifically a multidisciplinary osteoporosis clinic.