Low Rates of Bone Health Evaluation Before and After Primary Fragility Fractures

Osteoporotic fractures pose a critical challenge in patient care, with earlier work pointing to a significant shortfall in preventing subsequent fractures. This study aimed to determine the rate and predictors of bone health evaluations (BHE) before and after an operatively treated first-time fragility fracture and assess the imminent risk of a subsequent fracture.

This retrospective cohort study at a level I trauma center included patients aged 60 years or older who underwent surgery for fragility fractures (hip, pelvis, wrist, humerus, or femur) due to low-energy mechanisms between 2012 and 2022. Patients with a history of pathologic fractures, malignancies, or metabolic and autoimmune diseases affecting bone density were excluded. Demographic data, medical history, and details regarding BHE and fracture characteristics were collected. BHE was defined as a specialist-led management/education session, with or without a dual-energy X-ray absorptiometry scan.

Six hundred two patients (71% female; median age 78 [interquartile ranges {IQR}: 68-87]) with primary fragility fractures were identified. Within this cohort, only 13 (2.2%) had a documented BHE before fracture. Of the remaining 589 patients, 178 (30.2%) were referred for BHE after primary fragility fracture, but only 27 (4.6%) received it. Secondary fragility fractures were diagnosed in 69 patients (11.5%) after an average of 2.2 years (IQR: 1.04-3.75). Among this group, no statistically significant differences were found about patient characteristics or demographics. When comparing patients with and without secondary fragility fractures, there was no statistically significant difference in the overall rate of BHEs. Younger patients (p = 0.015) or those with a family history of osteoporosis (p < 0.001) were more likely to seek BHE.

There is a marked scarcity of BHEs both before and after primary fragility fractures, despite the established risks. Much work needs to be performed to improve referral and patient participation in BHEs after a first-time fragility fracture.