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.