November 2, 2009

Fracture Patients Lack Treatments To Prevent Future Breaks

A University of Cambridge study suggests that women who have suffered a bone fracture are not receiving treatment to protect against future breaks.

The researchers conducted an audit of 1,600 women who had visited a specialist clinic with a bone fracture, and found that 31% had suffered a previous break.  However, just 28% had been given the recommended bone-protective drugs.

BBC News quoted one of the doctors involved in the study as saying that while more could be done to identify patients at risk, side effects had stopped some women from taking the drugs.

The risk of osteoporosis, a condition in which bones become fragile and break easily, rises naturally with age.  The most common fractures involve bones of the hips, spine and wrist.

Current guidelines from Britain's National Institute of Health and Clinical Excellence call for women over the age of 75 who have suffered a fracture to be offered preventive treatment with drugs such as bisphosphonates.

Due to the high risk of future fractures after a break, postmenopausal women under the age of 75 are advised to have a bone density scan before being offered treatment.

But experts say the guidelines are insufficient, and that more women with signs of bone weakening should receive the drugs.

The latest study found that 526 of 1641 postmenopausal women visiting a fracture clinic had suffered a previous bone break.  Of those, 27% were taking a bisphosphonate or other treatment such as calcium or vitamin D supplements.

Among those greater than 75 years of age, just 45% were receiving bone protective therapy.

Professor Julia Compston, who led the study, said the low levels of treatment were "broadly applicable" to the entire country.

Reasons for lack of treatment include poor recording of fractures in patient records, absence of incentives for doctors to treat osteoporosis and the fact that patients can "get lost" between hospitals and doctors due to poor communication.

"Someone needs to take responsibility for deciding whether a patient should be treated and there are a lot of processes that can fall down," she told BBC News.

"Patients also need to be better informed that they might need treatment," she said, adding that access to bone density scans is problematic in some areas of Britain.

Professor Steve Field, chairman of the Royal College of GPs, said the analysis underscored that more could be done to ensure treatment is made available.

"But these drugs can have very unpleasant side-effects - so some patients are offered them but stop taking them," he told BBC News.

"Exercise and diet are also important."


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