Secondary prevention of osteoporosis after Colles fracture: Current practice

Colles fracture in the elderly is accepted as evidence of osteoporosis. NICE (National Institute of Clinical Excellence) recommends osteoporosis treatment in all fragility fractures over 75 without a DXA (Dual Energy X-ray Absorptiometry) scan and after DXA scan in younger patients. All clinicians involved in the patient's care are said to be responsible for this.

We reviewed current practice in United Kingdom to find out the role played by orthopaedic surgeons in organising this treatment. We sent a questionnaire to 150 BOTA (British Orthopaedic Trainees Association) members by e-mail.

The response rate excluding bounced mails was 63%. Only 5% of respondents prescribed osteoporosis treatment and 32% requested general practitioner to do this. Twenty-four percent referred the patients for either DXA or to an osteoporosis service. Although 86% were aware of NICE guidelines regarding osteoporosis, only 35% thought it could amount to negligence on the surgeon's part for not dealing with this. Fourteen percent worked in hospitals having an osteoporosis service which co-ordinated further management of these patients. Eleven percent expressed concerns over the source of funding for the management of osteoporosis and said that this was the reason for not offering treatment themselves.

This survey highlights the importance of concrete local protocols in management of osteoporosis especially secondary prevention after an osteoporotic fracture. At present, it appears to be safe practice to indicate this in correspondence to patient's general practitioner and inform the patient as well.