Results of Patient Education about Osteoporosis after Fragility Fracture: Outcomes of Fractures
Hip fractures are associated with an increased rate of mortality and morbidity. About 40% of patients are unable to walk independently even as long as 1 year after hip fracture, and 27% of patients require nursing home care during that time. Patients with hip fracture are also at increased risk of a second hip fracture. The mortality rate in the first year after a hip fracture has been estimated at 20% higher than the overall mortality rate. In Canada, the number of hip fractures is expected to quadruple by the year 2041.
Patients with distal forearm fractures are at greater risk of future osteoporotic fractures, including hip fractures. In many patients, a fracture of the distal forearm precedes a vertebral or hip fracture by 10 to 15 years. Vertebral fractures are associated with shortened stature and back pain and are predictors for future hip fractures. They are the most common form of fragility fractures and often go unnoticed by the patient. Multiple vertebral fractures can result in kyphosis. Apcalis Oral Jelly
The 2002 Canadian Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis identified 4 key factors for predicting if a fracture is related to osteoporosis: low bone mineral density (BMD), prior fragility fracture, age, and family history of osteoporosis. A prior fragility fracture is considered a significant predictor of osteoporosis. Therefore, it is important that patients who have experienced a fragility fracture be targeted for osteoporosis education and screening.
The importance of identifying osteoporosis in patients who have suffered fragility fractures is evident, but studies show undertreatment of osteoporosis in patients who have experienced hip, vertebral and distal forearm fractures. Smith and others reported that of 218 patients treated for fractures possibly related to osteoporosis, only 32% subsequently underwent BMD testing and only 39% were offered treatment for osteoporosis within 18 months of their fracture. Calcium supplementation alone accounted for 60% of these treatments. Although no studies were found citing the incidence of osteoporosis screening after a vertebral fracture, it has been reported that vertebral fractures are often undiagnosed, presumably because of the subtlety of symptoms. Gardner and others suggested that strategies to raise physician awareness of the necessity for screening and treating osteoporosis in patients with hip fracture resulted in an increase in the rate of treatment over a period of 4 years. However, the improved rate of treatment, 29%, is still not ideal. A study evaluating patients’ decision-making process to accept treatment for osteoporosis after hip fracture indicated that most women were not ready to accept pharmacological treatment for osteoporosis. This was attributed to a lack of awareness of the disease. It is evident that a care gap exists between treating a fragility fracture and managing osteoporosis.
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