Strikingly High Prevalence of the Risk Factors for Low Bone Mineral Density and Estimated Fracture and Fall Risk Among Medical Inpatients: A Missed Opportunity
Kamil Khan, Lorraine Thong, Kabir Ali, Fayyaz Janjua, Muhammad Haroon
Division of Rheumatology, Department of Medicine, Kerry General Hospital
1) to calculate the absolute fracture risk by examining the clinical risk factors used in fracture risk assessment (FRAX) model and to determine the proportion of patients whose absolute fracture risk exceeds the National Osteoporosis Foundation (NOF) thresholds for treatment; 2) to assess the risk of falls, especially among patients with increased risk of fractures; 3) to examine the patient’s knowledge of osteoporosis and to investigate the patterns of any osteoporosis-related investigations and treatments used in these patients.
A questionnaire-based study and was carried out in two steps. The first step involved having a short interview with the patient and fall assessment was made by using Fracture Risk Questionnaire (FRQ), and in the second step their clinical records were reviewed to populate the 11 clinical risk factor variables used in the FRAX model. The study participants were all inpatients aged ≥50 years admitted to the medical wards at Kerry general Hospital. For the whole cohort, FRAX risk scores were calculated without information on bone density.
Consecutive 200 medical inpatients were evaluated, and the mean age of the cohort was 73.8±9 years. Previous personal history of low fragility fracture was present in 20.5% (n=41) of patients. Only 21% (n=42) of patients reported having had a DEXA scan and 62.5% of the cohort (n=125) was familiar with osteoporosis. Only 31% (n=62) of the cohort was currently using some form of bone-related treatment (supplemented page 51 calcium and vitamin D only, n=48, 24% of the cohort; oral bisphosphonates 6.5% of the cohort, n=13; only one patient was using hormone replacement therapy). 63% of patients were noted to be at the risk of fall. The absolute 10 years risk of major osteoporotic fracture was 15±12, and of hip fracture was 7.6±11. We noted that 25.5% (n=51) and 64.5% (n=129) of the cohort had fracture risks exceeding the NOF thresholds for treatment.
A very high prevalence of elevated fracture and fall risk was noted. A medical inpatient stay offers a window of opportunity for assessment of osteoporotic fracture risk and the initiation of appropriate bone protection.