Are osteoporotic fractures being adequately investigated? A questionnaire of GP & orthopaedic surgeons

Abstract

Background: To investigate the current practice of Orthopaedic Surgeons & General Practitioners (GP) when presented with patients who have a fracture, with possible underlying Osteoporosis.

Methods: Questionnaires were sent to 140 GPs and 140 Orthopaedic Surgeons. The participants were asked their routine clinical practice with regard to investigation of underlying osteoporosis in 3 clinical scenarios. 55 year old lady with a low trauma Colles fracture. 60 year old lady with a vertebral wedge fracture. 70 year old lady with a low trauma neck of femur fracture.

Results: Most doctors agreed that patients over 50 years old with low trauma fractures required investigation for osteoporosis, however, most surgeons (56%, n = 66) would discharge patients with low trauma Colles fracture without requesting or initiating investigation for osteoporosis. Most GPs (67%, n = 76) would not investigate a similar patient for osteoporosis, unless prompted by the Orthopaedic Surgeon or patient. More surgeons (71%, n= 83) and GPs (64%, n = 72) would initiate investigations for osteoporosis in a vertebral wedge fracture, but few surgeons (35%, n = 23) would investigate a neck of femur fracture patient after orthopaedic treatment.

Conclusion: Most doctors know that fragility fractures in patients over 50 years old require investigation for Osteoporosis; however, a large population of patients with osteoporotic fractures are not being given the advantages of secondary prevention.

Figure 1

Clinical scenario of low trauma Colles fracture. The routine practice of GP's & Orthopaedic Surgeons with regard to investigation of underlying Osteoporosis in a 55 year old lady with a low trauma Colles fracture.

Figure 2

Clinical scenario of low trauma vertebral wedge fracture. The routine practice of GP's & Orthopaedic Surgeons with regard to investigation of underlying Osteoporosis in a 55 year old lady with a low trauma vertebral wedge fracture.

Figure 3

Clinical scenario of low trauma fracture neck of femur. The routine practice of GP's & Orthopaedic Surgeons with regard to investigation of underlying Osteoporosis in a 55 year old lady with a low trauma fracture neck of femur.