ASSESSMENT OF FRACTURE RISK AND OSTEOPOROSIS IN PATIENTS OF 50 YEARS AND OLDER WITH A RECENT FRACTURE

Background: The Dutch Guidelines for Osteoporosis (April 2002) recommend a case-finding strategy based on risk factors. A fracture in a woman above the age of 50 years is one of the risk factors, which should lead to BMD (bone mineral density) assessment. It is known from the literature that osteoporosis is under-diagnosed and therefore under-treated.Objectives: The aim of this project is to implement case-finding for osteoporosis in patients with a recent fracture diagnosed in the Emergency Department according to the Dutch Guidelines.Methods: All patients of 50 years and older who came to the Emergency Department of two hospitals (VU University Medical Centre and Slotervaart Hospital) with a fracture were invited to participate. Polytrauma patients and patients with skull fractures were excluded. From January 2003, till January 2004, 1067 patients were invited to participate in the study. All patients received information about osteoporosis and a questionnaire on the following risk factors: previous fractures, vertebral fracture; mother with hip fracture; low body weight; serious immobility; use of corticosteroids.The risk score was calculated according to the Dutch Guidelines in the 397 (37%) patients who completed the questionnaires and in whom DXA of the spine and hip were performed. Osteoporosis was defined as a T-score of –2.5 or less at the spine and/or hip. The results of the case-finding were used to evaluate the incidence of osteoporosis in patients with fractures and in patients with high risk scores. An advice was prepared for the general practitioner based on risk score and BMD. The advice included the diagnosis, and the proposed treatment (no treatment, calcium and vitamin D, bisphosphonates or raloxifene, referral to a specialist).Results: From the 1067 included patients, 254 (23.8%) were men and 813 (76.2%) women. 475 (44.5%) patients completed the questionnaires and 397 (37.4%) underwent DXA. Wrist fracture was the most common of all fractures (n=286, 26.8%). The patients were diagnosed as follows: normal BMD 99 (24.8%), osteopenia 186 (46.6%), osteoporosis 112 (28.4%). The advice in the first 390 evaluated patients were: no treatment or extra calcium and vitamin D in 207 patients (51.9%); treatment with bisphosphonates or raloxifene in 124 patients (31.1%), including all patients with osteoporosis and some patients with osteopenia and several risk factors; referral to the specialist in 46 patients (11.5%) with severe osteoporosis in young patients; and continuation of treatment in 13 (3.3%) patients who already were treated for osteoporosis.Conclusion: The acceptance of this case-finding program by the patients is moderate: 44% returned the questionnaire and 37% came for DXA. However, from 397 patients who did participate in the study, 170 (42.6%) were proposed a treatment or a referral to the specialist, while only 13 (3.3%) of these patients were treated before. Therefore, case-finding for osteoporosis in patients with a recent fracture is a successful strategy.Citation: Ann Rheum Dis, volume 64, supplement III, year 2005, page 359Session: Osteoporosis – Clinical aspects and treatment