Secondary and tertiary prevention in the management of low-trauma fracture

A significant risk factor for osteoporotic fracture is a previous atraumatic fracture. The objective of this study was to investigate whether patients with Colles fracture from minimal trauma were subsequently identified, assessed and treated for their elevated risk of fracture. Medical records at Sir Charles Gairdner Hospital in Perth, Western Australia, from August 1999 to July 2000 were audited and 111 patients who had sustained a Colles fracture from minimal trauma were identified. Questionnaires were subsequently posted to participants to determine whether any assessment or treatment was undertaken outside the hospital system. According to documentation in the medical records, 9% (10/111) had their bone mineral density assessed, 15% (17/111) were receiving medical therapy for osteoporosis, 7% (8/111) had their falls risk assessed and 51% (58/111) were seen by a physiotherapist. Of the 58 who received physiotherapy, 76% (44/58) received upper limb exercises and 19% (11/58) received lower limb or balance exercises. Follow-up questionnaires one to two years after the fracture were returned by 43% (48/111) of the sample. By this time, 37% (18/48) had BMD assessed and 27% (13/48) were receiving medical therapy for osteoporosis. Thirty-five per cent (17/48) of patients recalled being advised to increase their calcium intake. Of those who reported more than one fall during the past 12 months, 62% (8/13) had been seen by a physiotherapist, 46% (6/13) reported having their balance assessed and 54% (7/13) reported having a home visit for assessment of rails etc. Despite the availability of effective treatments, a substantial proportion of patients with Colles fracture from minimal trauma are not all being identified, assessed or treated for their elevated risk of subsequent osteoporotic fracture.