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

Area of Science:

• Orthopedics
• Geriatrics
• Public Health

Background:

• Osteoporotic fractures represent a significant healthcare burden, with a notable failure to prevent subsequent fractures.
• Fragility fractures in older adults are a growing concern, highlighting the need for effective bone health management.

Purpose of the Study:

• To determine the rates and predictors of bone health evaluations (BHE) before and after surgically treated first-time fragility fractures.
• To assess the risk of subsequent fractures following initial fragility fractures.

Main Methods:

• Retrospective cohort study of patients aged 60+ undergoing surgery for fragility fractures (hip, pelvis, wrist, humerus, femur) due to low-energy mechanisms.
• Exclusion of patients with pathologic fractures, malignancies, or metabolic/autoimmune bone diseases.
• Data collection on demographics, medical history, BHE, and fracture characteristics; BHE defined as specialist-led management/education with or without DXA scan.

Main Results:

• Only 2.2% of 602 patients had a BHE before their first fragility fracture.
• Post-fracture, 30.2% were referred for BHE, but only 4.6% received it.
• 11.5% experienced secondary fragility fractures; no significant difference in BHE rates between those with and without secondary fractures.

Conclusions:

• There is a significant deficit in bone health evaluations both before and after initial fragility fractures.
• Enhanced strategies are required to improve BHE referral rates and patient engagement following fragility fractures to mitigate future risks.