High prevalence of missed opportunities for secondary fracture prevention in a regional general hospital setting in Singapore

• Published in: Archives of osteoporosis Vol. 12; no. 1; p. 60
• Main Authors: Gani, Linsey, Reddy, Saripalli K., Alsuwaigh, Rayan, Khoo, Joan, King, Thomas F. J.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.12.2017
• Subjects: Adult; Age Factors; Aged; Bone Density Conservation Agents - therapeutic use; Dietary Supplements - utilization; Drug Utilization - statistics & numerical data; Endocrinology; Female; Hospitalization; Hospitals, General - standards; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteoporosis - diagnosis; Osteoporosis - drug therapy; Osteoporosis - epidemiology; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - prevention & control; Prevalence; Quality of Health Care; Recurrence; Retrospective Studies; Secondary Prevention - methods; Secondary Prevention - standards; Sex Factors; Short Communication; Singapore - epidemiology; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin D Deficiency - epidemiology; Young Adult; Prevention; Osteoporosis; Treatment gap; Fracture
• ISSN: 1862-3522; 1862-3514
• DOI: 10.1007/s11657-017-0356-x

Summary This study aims at assessing the gap in secondary fracture prevention at a regional general hospital setting in Singapore. Male patients have significantly lower rate of being investigated and treated for osteoporosis than their female counterparts. Vitamin D deficiency is prevalent in our population. Purpose Secondary fracture prevention services are not routine in Singapore; we seek to assess the treatment gap that exists in the lack of diagnosis and treatment of osteoporosis in fragility fracture patients. Methods We performed a retrospective analysis of all admissions for fragility fractures between December 2013 and December 2014. Demographic data, rates of BMD performance, serum vitamin D investigation and calcium and vitamin D supplementation as well as antiresorptive initiation 1 year post admission were analysed. Results There were 125 fragility fractures in patients below 65 and 615 fractures in older patients. There was a slightly higher proportion of males in the younger population, whereas females predominated in the older population. Median vitamin D levels were low in both younger (19.1 μg/L) and older (22.0 μg/L) groups, but supplementation was lower in younger patients (4.8 versus 16.6%, p  = 0.003). Rate of BMD performance was lower in younger patients (34.4 versus 64.6%, p  < 0.01); there was a significant difference of BMD performance between male and female patients in the younger population (19.1 versus 52.8%, p  < 0.01) which was not present in the older age group. Antiresportive initiation was significantly lower in the younger age group versus older (10.4 versus 31.5%, p  < 0.01); male patients in the younger and older age groups had significantly lower antiresorptive initiation rate compared to the females. Conclusion There is a significant treatment gap in diagnosis and treatment of osteoporosis in fragility fracture patients in a regional hospital setting in Singapore. Male osteoporosis remains inadequately investigated and treated in both age groups .