Rationale and evidence
Rationale
Studies of patients with osteoporotic fractures have found that they are at significantly greater risk of suffering a new fracture compared to the general population. This risk is particularly marked in but not restricted to elderly patients, particularly given that recent clinical guidelines recommend that all individuals over the age of 50 who sustain a fracture following minimal trauma (such as a fall from standing height or less) should be considered to have a presumptive diagnosis of osteoporosis. Despite this, there have been reports of insufficient provision for the management of these patients before discharge.
Osteoporosis assessments and/or treatments before discharge are clinically very important and moreover may be highly cost effective even after taking account of the additional resources associated with providing these services.
Evidence
Johansson H, Siggeirsdóttir K, Harvey N. et al. Imminent Risk of Fracture After Fracture. Osteoporos Int. 2016; 28 (3): 775-780.
Johnell O, Kanis JA, Odén A, et al. Fracture risk following an osteoporotic fracture. Osteoporosis Int. 2004; 15:175-9.
Lih A, Nandapalan H, Kim M, et al. Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Osteoporos Int. 2011; 22(3):849-58.
McLellan AR, Wolowacz SE, Zimovetz EA, et al. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int. 2011;22(7): 2083-98.
Otmar R, Henry MJ, Kotowicz MA, et al. Patterns of treatment in Australian men following fracture. Osteoporos Int. 2011;2 2(1): 249-54.
The Royal Australian College of General Practitioners and Osteoporosis Australia. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2nd edn.
Teede HJ, Jayasuriya IA, Gilfillan CP. Fracture prevention strategies in patients presenting to Australian hospitals with minimal-trauma fractures: a major treatment gap. Intern Med J. 2007; 37(10): 674-9.