Only a quarter of hip fracture patients leave hospital with an osteoporosis plan to reduce the risk of further breaks, found the latest hip fracture registry report.

The finding has lead the report authors to call for more priority to be placed on initiating osteoporosis treatment and individualized patient plans to prevent falls and fractures.

The 2018 annual report of the Australian and New Zealand Hip Fracture Registry (ANZHFR) has just been released. It looks at trends in the incidence and treatment of hip fractures resulting from a minimal trauma injury, like a fall, in people aged over 50, with a common risk factor being bones weakened by osteoporosis.

However, data from the report shows only 25 percent of patients in New Zealand who undergo surgery leave hospital on active treatment for osteoporosis and only 24 percent of hospitals provide individualised written information on prevention of future falls and fractures.

Professor Jacqueline Close, geriatrician and co-chair of the ANZHFR, said that, while the data showed an improvement over last year’s report, New Zealand and Australia were still significantly behind other countries in closing the osteoporosis care gap.

‘There are huge opportunities to further improve hip fracture care, including the prevention of future falls and fractures. Strong evidence exists to support treatment of osteoporosis in this population yet all too frequently we fail to offer treatments which can impact on people’s lives,’ said Close.

‘Hospitals need to work towards closing the care gap to ensure hip fracture patients go home with an individualised care plan designed to prevent future fractures.

She said general practitioners and other health practitioners also play a critical role in ensuring that bone health is addressed and that treatments are offered on an ongoing basis for our older New Zealanders unfortunate enough to break a bone from a fall.’

 

Although the rate of low trauma hip fractures has decreased over time, the actual number of fractures continues to increase due to the rising number of older people.

‘Our goal is to highlight the current gaps in care and work with hospitals across New Zealand and Australia to increase the uptake of proven, evidence-based treatments,’ said Dr Roger Harris, clinical lead for the hip fracture registry in New Zealand.

‘We also need to work in partnership with general practitioners who have a key role in managing chronic diseases such as osteoporosis.’

In New Zealand, the Live Stronger for Longer initiative is a multi-sector, system-wide response to the threat that falls and fractures present to older people.

A key focus of the initiative, that also includes the hip fracture registry, is the implementation of fracture liaison services (FLS).

The purpose of FLS is to ensure that all people who have fractures caused by osteoporosis undergo bone health assessment, receive osteoporosis treatment where needed and are referred to strength and balance programmes to prevent future falls.

Since a major investment by the Accident Compensation Corporation (ACC) in 2016, and considerable local investment from district health boards (DHBs), access to FLS across New Zealand has improved.

‘FLS are internationally recognised as the best model of care to ensure we do our best to make the first osteoporotic fracture the last,’ said Christine Gill, executive director of Osteoporosis New Zealand.

‘As of August 2018, New Zealand has in fact become the first country in the world to provide universal access to FLS. With FLS teams working hard across the country to ensure every fracture patient receives the care that they need, a significant improvement in the management of osteoporosis after hip fracture should be evident in next year’s ANZHFR report.’

Other findings:

  • The median length of stay in ED for a hip fracture patient is 5 hours in NZ and 6 hours in Australia
  • The median time between arriving in hospital and getting hip fracture surgery is 30 hours on both sides of the Tasman (the average is 39 hours)
  • 8% of hip fracture patients were on active medication treatment for osteoporosis before their surgery (37% were taking calcium and/or vitamin D)
  • 25% of hip fracture patients left hospital on active osteoporosis treatment (bisphosphonate, denosumab or teriparatide)
  • 74% of hip fracture patients underwent a falls assessment during their in-patient stay (81% in Australia)
  • Median length of stay is 7.3 days in acute ward and 59% of patients are transferred to rehabilitation (Australia median stay in acute ward is 7.7 days and 51% go to rehab)

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