Article
Diagnosis and pretreament of osteoporosis in elder patients before low-energy fracture in a German trauma center
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Published: | October 23, 2017 |
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Objectives: In accordance with current guidelines, low-energy fractures in elder patients are an indication to start with osteoporosis diagnostic and anti-osteoporotic drug-therapy. However, only few data, how these recommendations are implemented, are available. Aim of this study was to compare the incidence of preexisting and treated osteoporosis in elder patients with a new fracture in relation to prior fractures.
Methods: 399 patients over 60 years of age who were admitted consecutively to a German trauma center due to a low-energy-fracture of their spine, femur, humerus or forearm between 03/2014 and 04/2015 were recruited. All received a standardized interview, including questions for prior diagnosis and risk factors for osteoporosis (e.g. hip fracture, prior risk-fracture for osteoporosis at age >50, smoking, alcohol abuse, medication, chronic lung disease, diabetes, Bechterew's disease, epilepsy, etc), medication and other comorbidities.
Results and Conclusion: 34% (134/399) suffered from a prior risk-fracture after the age of 50, from which 54% (73/134) had been tested for osteoporosis by measuring bone-marrow-density via dual-energy X-ray absorptiometry (DXA) compared to 36% (95/134) in patients without a prior indicator fracture. 68% (50/73) of the tested patients with a prior fracture showed a positive result in DXA. 22% (30/134) of patients with a prior indicator fracture were treated with anti-osteoporotic medication before the current admission compared to 11% (30/134) without a prior fracture.
Only 21% (84/399) of the patients were aware of a prior osteoporosis diagnosis, although the prevalence in Germany for women >50 years is estimated to be 39%. Use of osteoporosis medication was reported in 15% (60/399) of the patients, anti-resorptive therapy in 7% (28/399).
Prevalence of diagnosed osteoporosis and its treatment following risk-fractures in our patient cohort is lower than expected from the literature. Expedient risk assessments are necessary to indicate further diagnostics and therapy of osteoporosis to ensure correct diagnosis and efficient therapy, especially in patients with obvious risk factors.