Introduction
Current evidence suggests that early rather than late administration of bisphosphonates prevents refracture after fragility fractures. [1] It has been previously proven that there remains a significant treatment gap in the prescription and timing of anti-fracture therapy. [2]
Objective
To determine 1) whether patients with fragility fractures are receiving anti-resorptive therapy and the time frame in which this occurs 2) the recognition and treatment of vitamin D deficiency in these patients.
Methods
A retrospective analysis of medical records and laboratory data of patients with fractures was performed. Vitamin D levels, renal function and management of fractures were also analyzed.
Results
A total of 205 patients (F 154/M 51, mean age 80 years) presented to Box Hill Hospital with fractures from June-Dec 2013. The most common fracture was femur (N=112, 60%), followed by humerus (N=44, 21%) and Colles (N=36, 18%).
Out of 180 patients with osteoporosis, only 32 (17%) had bisphosphonates started, at a mean time of 26 days. Forty-seven (27%) patients were commenced on vitamin D, whilst 7 (4%) patients were started on calcium.
Seventy (41%) out of 107 patients had vitamin D deficiency, however less than half (N=33, 43%) were treated.
Initiation of anti-resorptive therapy was predicted in patients with a history of osteoporosis (P = 0.002), Caucasian ethnicity (P = 0.049) and femoral fractures (P=0.029). Others including age (P = 0.323), gender (P = 0.408) and osteoporotic risk factors (P = 0.108) did not influence the decision to start therapy.
Conclusion
Fragility fractures and vitamin D deficiency do not appear to be treated with adequate pharmacological therapy. Measures need to be undertaken to improve awareness amongst medical practitioners.