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Assessing endocrinology referral rates and osteoporosis directed-care after upper extremity fragility fractures
Annika N Hiredesai1, Alejandro M Holle2, Camryn S Payne2
1Mayo Clinic Alix School of Medicine, 5951 East Mayo Boulevard, Phoenix, AZ, 85054, USA. hiredesai.annika@mayo.edu.
Abstract:
Upper extremity fragility fractures (UEFFs) often fail to prompt osteoporosis evaluation. In 99 UEFF patients, only 25% received endocrinology referrals, 51% underwent DXA scans (median 301 days post-fracture), and 20% initiated treatment, with males less likely to receive scans (18% vs 55%, p = 0.028). Standardized referral protocols and improved awareness are needed to address care gaps, particularly for males.
Purpose:
Upper extremity fragility fractures (UEFFs) are frequently overlooked as osteoporosis indicators, leading to missed care opportunities. This study aimed to (1) assess the endocrinology referral rate following UEFFs, (2) evaluate rates of osteoporosis-directed care initiation, and (3) identify risk factors for lack of osteoporosis-directed follow-up after UEFF.
Methods:
Patients with distal radius or proximal humerus fractures (2013-2023) at a United States level III trauma center were analyzed. Exclusions included high-energy trauma, prior osteoporosis therapy, age < 50, malignancy/Paget's disease, or < 1-year follow-up. Data included demographics, endocrinology referrals, DXA scans, pharmacotherapy initiation, and subsequent fractures. Risk factors were analyzed using Fisher's exact/chi-square tests.
Results:
A total of 99 patients met inclusion criteria with 85 (86%) patients sustaining a distal radius fracture and 14 (14%) sustaining a proximal humerus fracture. Of these, 25% were referred to endocrinology, 21% were seen by endocrinology, and 51% received a DXA scan after the index fracture. Only 20% were initiated on pharmacotherapy. The median time to DXA was 301 days (Interquartile range: 124-552 days), with only 17 (34%) patients receiving a scan within 6 months. Males were less likely to receive a DXA scan than females (18% vs 55%, p = 0.028).
Conclusion:
Most UEFF patients lacked timely osteoporosis evaluation, with males disproportionately affected. Standardizing referral protocols and improving osteoporosis awareness post-fracture may enhance early intervention and outcomes.
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