The aftermath of hip fragility fractures - are we missing out on osteoporosis treatment?"

Abstract

Introduction: Fragility fractures cause significant mortality and morbidity. Even though there are multiple guidelines for the management of fragility fractures, european countries still report treatment rates of less than 30%. Implementation of fracture liaison services can increase this percentage by 21%. Our goal is to describe the management of osteoporosis, in patients with hip fragility fracture treated in a portuguese hospital with no internal protocols in place.

Methods: A retrospective study was conducted. Patients treated surgically for hip fragility fracture in our hospital, during 2017, were included. Data until May 2020 was collected on osteoporosis recognition and pharmacological treatment prescription.

Results: A total of 102 patients were included, 87% female, with a mean age of 79.9±9.9 years at the time of the fracture. Pharmacological anti-osteoporotic treatment after the hip fragility fracture was prescribed in 35%. From those, 53% did not include bisphosphonates. General practice doctors were responsible for 44% of anti-osteoporotic prescriptions and "Osteoporosis" ICD10 codification in primary care was present in 10.7%.

Discussion/conclusion: We found a gap in osteoporosis treatment after a hip fragility fracture, similar to literature reports when no fracture liaison service is in place. We believe that the lack of such protocols, the low rate of "osteoporosis" or "fragility fracture" mentioning at hospital discharge, together with the under recognition at primary care level, contribute to this reality. The implementation of new measures is crucial to improve prevention and management of fragility fractures.