Secondary Prevention of Fragility Fractures: Short-Term Results of a Multidisciplinary Clinic

Objectives: Fragility fractures, constitute a major health problem and are a key risk factor for a subsequent fracture in osteoporotic patients. Studies have shown that multidisciplinary teams are most effective in prevention of these fractures, especially with involvement of the treating surgeon. In an evaluation of our medical system, we found that patients were unlikely to receive appropriate diagnosis, evaluation and treatment for secondary prevention of fragility fractures. We have since begun the implementation of a multidisciplinary anti-osteoporotic clinic designed to treat and follow-up patients with prior fragility fractures of the distal radius. The purpose of this series is to evaluate the short-term effect of this clinic on patients sustaining a distal radius fragility fracture (DRFF) in a large health maintenance organization.

Methods (series): Our cohort included all participants assigned to a tertiary, multidisciplinary, fracture prevention clinic. All patients treated surgically for a DRFF were eligible for the study. These were compared to a previous cohort of patients not treated in a secondary prevention clinic. The clinic consisted of a hand surgeon, endocrinologist and occupational therapist. The primary outcome measure was a second fracture during the follow up period.

Results: Thirty-eight patients were recruited. Two patients did not comply with treatment and were excluded. Patients were treated with bisphosphonates or Teriparatide and followed every six months. All patients went through rehabilitation with an occupational therapist according to physical capacities. Mean age was 70.7(12.4). Follow-up was 14.3 months (6.8). No complications of therapy or new fractures were documented. There was no difference in fracture occurrence at one year. Table 1

Conclusions: Short-term results of a multidisciplinary clinic for prevention of secondary fractures seem to support results in the literature. Long-term follow-up and more patients are needed for significant differences.