ISR Autumn Meeting 2019
2nd Place Premier Poster
A Systematic Review of the Irish Osteoporotic Vertebral Fracture Literature and the Diagnostic Gap in Patients Admitted with Hip Fracture
E McCabe, M Kelly, A Ibrahim, R Singh, C Armstrong, F Heaney, D Bergin, JP McCabe, JJ Carey
1. Department of Rheumatology, Galway University Hospitals 2. School of Medicine, National University of Ireland, Galway 3. Department of Trauma and Orthopaedic Surgery, Galway University Hospitals 4. Department of Radiology, Galway University Hospitals
Vertebral fractures (VF) are the most common osteoporotic fracture. They are associated with significant morbidity, mortality and are an important predictor of future fractures. The epidemiology of VF in Ireland is limited and a greater understanding of their scale and impact is needed.
We conducted a systematic review of the Irish osteoporotic VF literature in accordance with the PRISMA guidelines. We also assessed the prevalence of VF on CTPA in patients admitted with hip fractures to Galway University Hospitals using a blinded assessor who graded fractures by Genant classification. Subsequently the proportion that were reported by the original radiologist was determined. Discharge summaries and prescriptions were reviewed for osteoporosis diagnoses and appropriate treatment.
21 studies met the inclusion criteria with data on 191,903 patients with fractures. There was significant heterogeneity in the study designs and outcome measures including review of hospital admission claims data, surgical and medical interventions and the impact of a fracture liaison service. Using a prospective hip fracture database, 225/2122 patients had a CTPA available for analysis. 40% (90) of patients had a VF present on CTPA. Only 1 in 5 VF were previously reported. 24% had osteoporosis treatment recorded in discharge summaries or prescriptions.
There is a large deficit in studies addressing the epidemiology of VF in Ireland which reflects the current situation of osteoporotic spine care in Ireland. A significant proportion of these fractures remain undiagnosed and are not captured. Improved reporting is necessary to trigger osteoporosis assessments and initiate treatment.