Awareness of Osteoporosis and Compliance with Management Guidelines in Patients with Newly Diagnosed Low-Impact Fractures |
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Authors: | H Castel D Y Bonneh M Sherf Y Liel |
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Institution: | (1) Department of Internal Medicine ‘C’, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, IL;(2) Endocrine Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, IL;(3) Southern District of Clalit Health Services, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, IL |
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Abstract: | A pre-existing fracture is a strong predictor of additional osteoporotic fractures. Consequently, current guidelines emphasize
the need for treating patients with existing osteoporotic fractures. The present study aimed to assess the implementation
of osteoporosis guidelines in routine practice. To this end, we reviewed the hospital charts of women and men aged 50 years
and older with new fractures due to low or moderate impact treated in the emergency room, orthopedic surgery and rehabilitation
departments. Notation of osteoporosis as a contributing cause for the fracture, performance of screening laboratory tests
for possible secondary causes and treatment recommendations were abstracted from the record. In addition, we utilized the
centralized pharmacy and laboratory computerized databases of the largest health maintenance organization in the area to follow
dispensation of osteoporosis drugs and performance of screening laboratory tests in the community following fracture incidents.
During the corresponding periods of January and February 1998 and 1999, 183 patients aged 50 years and older with low-impact
fractures were treated in the emergency room only and 113 were hospitalized. Osteoporosis was rarely mentioned in the medical
documentation. During the 6 month period after the fracture incident at least 70% of the emergency room patients and 62% of
the hospitalized patients received no osteoporosis drugs. However, an encouraging significant trend toward increasing use
of osteoporosis drugs, both prior to and after a fracture incident, was noted between the two survey periods among the emergency
room fracture patients, but not among the hospitalized patients. Calcium supplements were the most commonly used osteoporosis
drug. Bisphosphonates, hormone replacement therapy, raloxifene and calcitonin were rarely prescribed. Men were less likely
than women to receive treatment for osteoporosis. Systematic laboratory evaluations for secondary causes of osteoporosis were
not performed. We conclude that despite extensive attempts at increasing awareness among health professionals and the public
at large, osteoporosis is still rarely singled out as a problem in patients with newly diagnosed low-impact fractures, and
the majority of them are not managed according to guidelines. Further studies should address specific problems in physicians’
and patients’ attitude that may account for the present situation.
Received: May 2000 / Accepted: January 2001 |
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Keywords: | :Drug treatment – Fractures – Osteoporosis |
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