The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

Common metabolic disorders among patients with neck of femur fracture reveals underdiagnoses and undertreatment of osteoporosis in the community (#225)

Mahbub Hasan 1 , Bernard Walsh 1
  1. John Hunter Hospital, Lambton Heights, NSW, Australia

Acute orthogeriatrics unit of John Hunter Hospital was involved in management of 1206 neck of femur fracture (NOFF) admissions sustained by minimum trauma (fall from standing height) in between February 2015 to February 2018. Retrospective audit was performed analysing admissions data of ICD 10 codes and data from Australia and New Zealand Hip Fracture Registry. Of these patients, average age 83.7 years, 68.7% (829) were female, 1.1% were aboriginal, 30.4% were from residential aged care facility, 42.5% were not requiring any walking aids, and 58.1% were with normal cognition. Overall, 27.6% patients had at least one common metabolic condition (19.3% Type 2 diabetes, 5.8% either hypo or hypernatremia, 1.1% hypo or hypercalcemia, 0.7% thyroid disorders, 0.7% obesity) which is significantly underestimated as dyslipidaemia is not captured despite substantial number of patients were on at least one antidyslipidemic medication (combined data extraction from hospital pharmacy registry and community records are in progress) either for primary or secondary prevention, only 2.7% patients were weighed during the admission. On presentation, 55.5% patients were not on any bone protective agents, 31.6% were on calcium and or vitamin D supplementation and 12.6% on bisphosphonate or another potent bone modifying agent. During discharge, these figures changed to 13.7%, 51.7% and 30% respectively (4.6% not recorded). Overall there is a rise of 37.5% in receiving bone protective agents as a result of admission. More recently during first quarter of 2018, direct questioning collected data from another 52 patients with NOFF revealed 88.5% patients or their relatives (19.2% with established dementia) did not have any discussion regarding fracture risks. Assessments of risk factors are incorporated in RACGP osteoporosis algorithm, however recognition of these risk factors (especially common metabolic disorders as risks) and addressing risks with bone protection agent remains significantly underachieved, potentially contributing to increased number of NOFF.