Background/Purpose:

The worldwide incidence of hip fractures in men is rising, and by 2050 is projected to increase by 310%. Increased hip fracture rates may be due to the number of undiagnosed, and therefore untreated, cases of osteoporosis. Established coordinated models for fracture care aim to improve treatment of osteoporosis following fragility fractures, and their implementation has been associated with reduction of subsequent fractures. However, these models vary and have not been uniformly adopted as a standard of care. The aim of this study was to assess osteoporosis management patterns in males with fragility fractures, using a VA system to identify an appropriate population of males at risk for osteoporosis and fractures.

Methods:

We performed a retrospective chart review using the VA Computerized Patient Record System. All patients who underwent bone densitometry (DEXA) between 2011 and 2016, and therefore presumed to be at potentially high risk for osteoporosis and fractures, were identified. Subjects were then stratified into two subgroups: those who had DEXA scans ordered in response to a fragility fracture (subgroup 1), and those who suffered a fragility fracture following their first DEXA (subgroup 2). To identify the impact of treatment on subsequent fractures, post-fracture management was evaluated in both groups. We assessed whether patients were treated following their fracture, whether they sustained a recurrent fracture, and what percentage of treated patients sustained subsequent fractures compared to the percentage of untreated patients who sustained subsequent fractures. Data was collected by three investigators, following a validated algorithm.

Results:

From among 45,000 patients with active records in the study time period, 1848 patients had undergone DEXA. Manual review of records for these 1848 patients identified 485 who had experienced a fragility fracture, including 170 of the 485 patients (9%) who had DEXA scans ordered in response to a fracture (subgroup 1). Overall, 68 (40%) of subgroup 1 patients subsequently suffered a recurrent fracture. 51 (30%) patients in subgroup 1 were treated for osteoporosis following their fracture; of these, 11 (23%) suffered a recurrent fracture, compared with 54 of 119 untreated patients (46%). Further, we evaluated post-fracture care in 315 patients who suffered a fragility fracture after a DEXA was obtained (subgroup 2). 22 of these patients (7%) were on treatment at the time of their initial fracture. Overall, 78 of 315 patients (25%) suffered a second, recurrent fracture. 198 (63%) were initiated on treatment following their first fracture. Among those receiving treatment, 26 of 198 (13%) suffered a recurrent fracture, compared with 28 of the 117 (24%) who did not receive treatment.

Conclusion:

Our data confirms the ability of treatment to reduce the risk of primary and secondary osteoporotic fractures in men, but underline that the number of male patients actually treated in response to DEXA and fracture is well below that mandated by available guidelines. Physicians should be educated on appropriate management of osteoporosis following fractures and an established model of care following fragility fractures may be helpful in this setting.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-post-fracture-management-in-males-at-a-veterans-affairs-health-system/