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

Abstract

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. 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 1year post admission were analysed. 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 (19.1μg/L) and older (22.0μg/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. 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.