SECONDARY PREVENTION OF FRAGILITY FRACTURES – ARE WE NEGLECTING THE MEN?

Abstract

Introduction: Fragility fractures are taking up an increasing amount of resources within Trauma departments. Women have a 1 in 3, men a 1 in 12 lifetime risk of sustaining an osteoporotic fracture with a previous fracture being the strongest independent predictor of sustaining a further fragility fracture, often within one year. Secondary prevention is therefore particularly important. Many guidelines give advice on secondary prevention in women, but very few mention men even though men have a higher morbidity and mortality after hip fractures.

Methods: A retrospective review was carried out including 91 patients (48 females, 43 males) who were admitted with a fragility hip fracture between March 2003 and April 2004. Data about age, sex, investigations and medication were collected from the case notes, GP surgeries and the bone densitometry database. Investigations and treatment were compared with current guidelines (SIGN 2003, NICE 2005). Data was analysed using SPSS Version 13.0.

Results: 33% of women and only 8% of men < 75 years of age were investigated for osteoporosis (DEXA scan) following their hip fracture (Fishers Exact Test, p = 0.32). In patients ≥ 75 years 25% of women and only 6% of men were treated with bisphosphonates (χ² = 4.18, p < 0.05). There was also a statistically significant difference in overall treatment including bisphosphonates and calcium/vitamin D between the sexes (χ² = 6.81, p < 0.05).

Discussion: This study shows that there is a great need for improvement in secondary prevention of osteoporotic fragility fractures in both sexes, but men are far less likely to receive investigations and treatment than women. It is therefore essential to include recommendations for men in future guidelines and to increase awareness of male osteoporosis. Orthopaedic surgeons should take responsibility for initiating the process of secondary prevention.