Published Jul-Sep 2022
Patients who live in low-access areas receive inadequate osteoporosis care after hip fracture
After many years of decline, the incidence of hip fractures caused by fragility has plateaued in the United States as rates of osteoporosis testing and treatment continue to decline.
The gold standard for diagnosis of osteoporosis is a dual energy X-ray absorptiometry (DXA) scan to assess bone mineral density, and prescription drug therapy is recommended for patients with known osteoporosis or osteopenia with a greater than or equal to 3% probability of hip facture or 10% probability for another osteoporosis-related fracture.
Despite the availability of these scans and effective treatments, osteoporosis remains both underdiagnosed and undertreated. Analyses have shown only 26% of eligible women have undergone osteoporosis screening and that many patients do not have access to a fracture liaison service (FLS), which helps post-fracture patients manage and treat osteoporosis to reduce their risk of future fractures.
A research team that included Sara Galli, MD, an orthopedic surgeon at Ochsner Health, studied osteoporosis care in a cohort of patients treated for hip fragility fracture at a Midwest academic medical center, prior to implementation of an FLS. They sought to establish baseline rates of osteoporosis-related care to compare with care once an FLS was implemented, as well as examine how this public health concern relates to healthcare access and quality.
In the 12 months following their fracture, only 17% of the 585 patients studied underwent vitamin D screening, 12% received a DXA scan and 17% began a new bone anti-resorptive medication, which increases bone strength. Only in-hospital Vitamin D screening was more common in patients from counties with low healthcare access; all other pre- and post-fracture care was more common for patients with greater healthcare access and quality. Rates of initiating treatment and/or obtaining a Vitamin D screen or DXA scan following hip fragility fracture were very low and were worse in patients from counties with low healthcare access and/or quality.
These results emphasize the importance of targeting high-risk groups with diagnostic tests and treatments for osteoporosis following hip fracture.
