Who is at risk of receiving inadequate care for osteoporosis following fragility fractures? A retrospective study.

BACKGROUND Osteoporosis is considered the most common bone disease in humans and the most common cause of fractures. OBJECTIVES To identify possible risk factors associated with a low level of care for osteoporosis in patients presenting acutely with the major types of fragility fractures, as well as in patients who remain undertreated following their discharge. METHODS We conducted a retrospective questionnaire-based cohort study. We searched our databases for patients admitted acutely with proximal humerus, distal forearm, thoraco-lumbar spine, and proximal femur fractures. A questionnaire was used to evaluate osteoporotic care including a referral to DEXA and any associated prescribed medication. RESULTS The study group included 114 patients or their caregivers. The osteoporosis care rate rose from 56.1% (n = 64) before admission to 71% (n = 81) at follow-up. Significant risk factors associated with a decreased care rate prior to admission were the presence of fewer than three comorbidities and a combination of male gender and young age. Continued neglect at follow-up was associated with the opposite risk factors, such as older age, multiple comorbidities, and polypharmacy. An additional finding was that treated patients had a significantly increased likelihood of presenting with vertebral fractures. CONCLUSIONS While the association of osteoporosis with the elderly may decrease screening rates among younger and healthier patients, fragility fractures may be viewed as "endstage" bone disease, rendering osteoporotic care inefficient.