Should women attending fracture clinics be counselled about osteoporosis?

Osteoporotic fractures cause much morbidity and mortality and are a great burden on health care resources. It is well established that hormone replacement therapy (HRT) reduces the risk of osteoporotic fracture; it is also known to be worth initiating therapy even when one osteoporotic fracture has occurred in order to reduce the incidence of further fractures. In this study, detailed questionnaires assessing risk factors for osteoporosis were given to all women aged 25-60 years attending a daily fracture clinic over a 10-week period, and their radiographs were studied for signs of early trabecular bone loss, in order to determine whether at-risk patients could be identified easily. The findings were that 50 per cent of the premenopausal women had lifestyle-related risk factors about which they could be counselled. Using current guidelines, 90 per cent of the peri- and post-menopausal group should be considered for HRT. Overall, only 7 per cent of patients who should be on HRT were receiving it. It was concluded that most of those at risk can be identified very simply in the fracture clinic. This aspect of fracture management is currently being neglected.