Poster Presentation The Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2014

Management of osteoporosis in patients admitted with hip and vertebral fractures – an audit at Lyell McEwan hospital (#293)

Nisha Venkatesh 1 , Peak Mann Mah 1 , Elaine Pretorius 1 , Anthony Zimmermann 1
  1. Department of Endocrinology, Northern Adelaide Local Health Network, Elizabeth, SA, Australia

Problem: Osteoporosis is a condition associated with significant morbidity, mortality and economic costs. It is a disease amenable to primary and secondary prevention. Our aim was to ascertain the quality of osteoporosis management by conducting an audit of patients presenting with minimal trauma hip and vertebral fractures to our facility.

Methods A retrospective audit of patients admitted with hip and vertebral fractures between January and December 2011 was conducted.

Results 143 patients were reviewed.

In 52 patients who had a prior diagnosis of osteoporosis:

  • 80% had risk factors for secondary causes of osteoporosis, warranting a review of their diagnosis and management.
  • 71% were receiving vitamin D or calcium prior to admission, increasing to 77% of patients on discharge.
  • 61.5% were receiving anti-resorptive treatment (bisphosphonates, strontium) prior to admission, increasing to 64% on discharge (bisphosphonates, strontium).

In 91 patients who had no prior diagnosis of osteoporosis:

  • 97.8% had at least one risk factor for osteoporosis.
  • 6% of patients had bone densitometry organised during their admission.
  • 26% were receiving vitamin D or calcium prior to admission, increasing to 38% on discharge.
  • Anti-resorptive treatment (bisphosphonates) was only started in 7.7% of patients on discharge.

A review of 101 clinical separation summaries, the documents that enable handover of the patient’s care back to their primary care clinician, was conducted (summaries of patients who were deceased, transferred or palliated were excluded; some summaries were not available for review). Specific reference to osteoporosis was recorded in only 11 summaries.

Conclusions For the majority of patients presenting with minimal trauma fractures to our facility there was a failure of the treating teams to consider osteoporosis as the underlying cause and to then initiate the appropriate investigations, treatment and organise follow up. We plan to introduce guidelines and a ‘Bone protection pack’ to address this treatment gap.

  1. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761-67.
  2. Reginster J-Y. Antifracture efficacy of currently available therapies for postmenopausal osteoporosis. Drugs. 2011;71(1):65-78.