Secondary prevention of osteoporosis: Calcium, Vitamin D and bisphosphonate prescribing following distal radial fracture.

Over 200,000 osteoporotic fractures occur in the UK annually. Patients with fragility fractures are at highest risk of further fracture, though preventative treatment has been shown to reduce subsequent fracture incidence. We reviewed the pre- and post-fracture medication (via the PCTs and in-patient discharge letters) of all patients over 55 years who suffered a distal radial fracture between April 2003 and November 2004. Complete data was available for 175 patients (170 female): 95 were in-patients, 80 out-patients. Following distal radial fracture, calcium and Vitamin D was prescribed for 39 patients (22%), bisphosphonates to 16 patients (9%) and only 15 patients (8.5%) were referred for DEXA scanning. Higher rates of prescribing were seen in hospital, with over half of all in-patients started on fracture prevention treatment; however, less than a half of these patients continued to receive this medication in primary care. We believe, the results demonstrate a lack of health promotion opportunities to prevent future fracture, which is a common finding across healthcare systems nationally. Although there is clear focus and impetus for developing falls prevention services nationwide, this enthusiasm has not been translated across to bone health, despite the potential savings in terms of morbidity, mortality and healthcare costs. Important deficiencies in local services have been identified, particularly with respect to communication between secondary and primary care. This study has added weight to secure funding for a fracture liaison nurse in our institution; we suggest others follow suit and employ similarly dedicated personnel to ensure assessment and treatment for the prevention of further fractures.