Recruitment Complete

This trial has been recently completed and is in preparation for publication. The abstract was presented at the Australasian Menopause society in Perth 2004

Background

The Jean Hailes Foundation in collaboration with Southern Health and the Monash University Institute for Health Services Research has completed a comprehensive survey into the recognition and treatment of osteoporotic fractures in individualized who present to hospital with a fracture. The survey has also been completed at 14 other sites around Australia and the results have been combined to provide an important insight into osteoporotic fractures in Australia.

Approved by the Southern Health Human Research and Ethics Committee as well as other relevant local research committees in each state.

Osteoporosis is a condition where bones become weak and may break. Common sites to fracture are the wrist, hip and spine. Bone loss is often gradual and without warning signs, until the disease is advanced and a major fracture has occurred. Osteoporosis affects around two million Australians. The elderly and women are particularly at risk with 85% of fractures occurring over the age of 65 years. Osteoporotic fractures are preventable ideally before they first occur but also after the first fracture prevention becomes even more of an imperative to prevent further serious complications.

The main risks for important fractures are age, female sex, risk of falls and the presence of prior fractures usually of the spine or back. Indeed after just one spine fracture, another is up to five times more likely within a year and the risk of hip fracture is increased dramatically in those with any prior osteoporotic fracture.

Osteoporotic fractures are preventable. Numerous therapies including calcium and vitamin D supplementation, falls prevention education and the use of hip protectors as well as a group of drugs called bisphosphonates (e.g. alendronate and risedronate) among others. Despite this, rates of detection of osteoporosis in those with existing fractures (the highest risk group) and utilisation of these therapies are low. International studies show that doctors are failing to recognise osteoporosis as a cause of fractures and are not consistently offering appropriate treatment or referrals, despite the psychosocial and economic consequences of further fractures. It is estimated that 80 – 90% of patients with fragility fractures of the spine, forearm or hip remain uninvestigated and untreated.

Investigators

Professor Helena Teede, MBBS, FRACP, PhD, Director Research Jean Hailes Foundation, Head of Diabetes Southern Health, Monash University Research Fellow - Dept Obstetrics and Gynaecology and Monash Institute of Health Services research.

Dr Chris Gilfillan MBBS, FRACP, PhD. Assoc Professor Monash University and Head of Medicine Frankston Hospital, Consultant Endocrinologist Southern Health.

Dr Indra Jayashuria MBBS, FRACP. Jean Hailes and Monash University Research Fellow

Study Aim

To improve our recognition and treatment of osteoporosis in those at highest risk of future fractures to optimize opportunities for prevention of future fractures by establishing the current practices for osteoporosis prevention around Australia. Based on these findings a project to overcome these difficulties called the Southern Health osteoporosis fracture prevention project will be launched.

Methodology

We performed a retrospective medical record review of men and women over the age of 65 years who present to Dandenong Hospital or MMC with a principle diagnosis of hip, wrist, rib or vertebral fracture. Data was collected by a research nurse and included demographic data, as well as the number, sites, severity and causes of fractures. We noted whether osteoporosis was diagnosed, any associated conditions and the patient’s risk factors for osteoporosis, including whether they have had a falls risk assessment. Additional information obtained included whether any tests to detect contributing diseases were ordered and whether osteoporosis was diagnosed. Information about whether patients were given any medication for the treatment of osteoporosis was recorded.

Outcome

Our results demonstrate that only 6% of patients admitted to SH with a minimal trauma osteoporotic fracture receive appropriate intervention. This is similar to results from around the country and highlights the need for urgent attention and improvement in this area. This is an indictment on our current health practices and requires significant cultural and behavioral change to overcome

Support

Dr Teede is supported by an NH&MRC CDA Fellowship, the study was in part supported by an unrestricted investigator initiated grant from Merck Sharpe and Dohme Australia.

Content updated September 20, 2005