Abstract
Summary
This study describes in detail the burden of caring for patients aged ≥ 50 years seen in one year with a fragility fracture in a large urban environment and shows that these fractures result in a long length of stay and significant mortality. Intervention to prevent further fracture was poorly done.
Purpose
To examine the epidemiology of fragility fracture in patients over age 50 years and record the number who received appropriate secondary prevention treatment.
Methods
All patients aged ≥ 50 years presenting with a fracture during the 12 months following July 1st 2011, to Auckland City Hospital or residing in central Auckland at the time of their fracture, were identified from hospital and Accident Compensation Corporation records. A random sample of 55% of these patient’s records were reviewed to establish the type of fracture, prior fracture and falls history, and use of bisphosphonates in the 12 months before presentation. Their length of stay (LOS) by type of fracture was recorded. The use of bisphosphonate drugs in the following 12 months was obtained from centralised national records of prescriptions.
Results
2729 patients aged ≥ 50 years presented with a fragility fracture in the central Auckland region in one year. Fifty-six percent of these patients were seen at Auckland Hospital and of these, 82% patients required admission with a mean LOS of 20 days (SD ± 24 days).The remaining 44% of patients were looked after in the private outpatient sector. Approximately 30% of the admissions were for hip fracture. Sixty-four percent of patients with a fragility fracture did not receive a potent bisphosphonate, 12% were considered not appropriate for treatment, and 24% received a potent bisphosphonate during their admission or in the next 12 months.
Conclusions
Approximately 1 in 18 people aged ≥ 50 years presented in one year with a fragility fracture.Secondary prevention strategies were poorly implemented. Additional resources for identifying and initiating secondary fracture prevention care such as a Fracture Liaison Service are urgently needed.
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Acknowledgments
We acknowledge with thanks a grant from Merck Sharpe and Dohme for salary support for the research nurse.
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Geoffrey Braatvedt has received financial assistance to attend scientific meetings from Merck Sharpe and Dohme and Eli Lilly. He has sat on an advisory board to MSD and received research grants from MSD and Eli Lilly.
Conflict of interest
Susan Wilkinson, Marilyn Scott and Roger Harris declare no conflict of interest. Paul Mitchell has undertaken consultancy for governments, national osteoporosis societies, healthcare professional organizations and private sector companies throughout the world relating to systematic approaches to fragility fracture care and prevention.
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Braatvedt, G., Wilkinson, S., Scott, M. et al. Fragility fractures at Auckland City Hospital: we can do better. Arch Osteoporos 12, 64 (2017). https://doi.org/10.1007/s11657-017-0353-0
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DOI: https://doi.org/10.1007/s11657-017-0353-0