Patient management after fragility fractures
Med Care. 2007 Sep;45(9):902-906. Assessment of the Clinical management of Fragility Fractures and Implications for the New HEDIS Osteoporosis Measure, Foley KA and others. PMID: 17712262. In a 2006 Update I review two similar studies to this one, both with the equally alarming results. The authors in the Foley and others study looked at a database of elderly female patients treated under Medicare for fragility fractures of the wrist, leg, vertebral, hip, arm, rib, ankle, scapula, or other locations. They then determined if there was either follow up osteoporosis treatment or diagnostic testing done within six months of the fracture. A total of 9% of those who had fractures received diagnostic screens and 13% received treatment. From 2000 to 2005 screening increased from 8.4% to 10.2%, respectively and treatment rates increased from 11.2% in 2000 to 14.8% in 2002 with a decline to 12.9% in 2005, although still higher treatment rates than in 2000. Statistical testing showed these small changes were significant over time with women fracturing in 2005 being 27% more likely to receive treatment than in 2000. They also found that women in capitated Medicare plans (a plan which pays physicians a specific amount per member per month), were 21% more like to receive treatment than those not in such a plan. The authors noted, "[In} Medicare beneficiaries with a fragility fracture from 2000 through 2005, the overall percent of women screened and/or treated remained low." This low screening and treatment rate is important. In fact, an abstract from 2000 by Klotzbuecher CM and others, noted that patients with a previous fracture were at 2-4 times the normal risk for an additional fracture. They concluded: "Patients with a history of prior fracture, therefore, should receive further evaluation for osteoporosis and fracture risk."
Editor's comments: As I've noted many times before on this Website, no one else is more interested in your health that you are. It is unfortunate, but sometimes you simply have to demand proper care for your condition. A fragility fracture in an older individual means you have osteoporosis unless or until diagnostic screening proves otherwise. If your orthopaedist doesn't refer you to the proper care provider for that osteoporosis screening, you must demand a referral be given to you. Another totally unnecessary fracture could be extremely painful and debilitating, if not fatal. It's your health, get involved in it.