ML3: MANAGEMENT OF OSTEOPOROSIS BY ORTHOPAEDIC SURGEONS IN AUSTRALIA

Abstract

Current evidence suggests that in Australia more than 80% of individuals are not receiving treatment for osteoporosis following an initial osteoporotic fracture. The earliest opportunity to identify many individuals with osteoporosis is following their first osteoporotic fracture, which is usually less severe than subsequent fractures. As these fractures are usually treated by orthopaedic surgeons it was decided to survey Australian orthopaedic surgeons to determine their understanding, attitudes and involvement in the management of osteoporosis.

Methods: The AOA in conjunction with the BJD distributed a questionnaire to 945 members. The results of 449 (48%) returned questionnaires were collated and sent to the Swedish National Competence Centre for Musculo-skeletal Disorders for analysis.

Results: Responding surgeons claimed to treat at least 24,000 osteoporotic fractures per year. Sixty per cent felt they had ‘none’ or ‘insufficient’ training in osteoporosis and considered they had ‘no’ or only ‘slight knowledge’ in managing the condition. Approximately 65% of surgeons either ‘never’ or only ‘sometimes’ initiated investigation or treatment of patients with osteoporotic fractures; only 11% ‘always’ or ‘very often’ initiated investigation or treatment. If an osteoporotic fracture is suspected most (70%) refer to a GP or osteoporosis specialist, with only 22% evaluating the condition themselves. Although 46% claimed that they referred patients for a BMD study always or most of the time, only 14% did so routinely. Fifty percent felt it was the GP’s responsibility to identify and initiate the evaluation of the underlying osteoporosis of patients with fragility fractures, compared with 29% who considered that this was the orthopaedic surgeon’s responsibility.

Eighty five per cent of the respondents do not prescribe any pharmacological treatment for osteoporosis management. Most commonly (36%) there was a preference for surgery rather than drug prescription. Twenty four percent had access to a specific osteoporosis team for treating osteoporosis. No experience with treating osteoporosis (23%) and no formal education in osteoporosis (16%) were other common reasons. Very few orthopaedic surgeons felt it was their responsibility to treat osteoporosis, however 52% were interested in attending a course on osteoporosis.

The findings are contrasted with those of an international study conducted by the Bone and Joint Decade and the International Osteoporosis Foundation, using the same questionnaire.

Conclusions: The evidence of under- treatment of osteoporosis after first fragility fractures, suggests that it may be necessary for orthopaedic surgeons to re-evaluate their approach to the management of osteoporosis, either by themselves or others. Further educational opportunities in this area should be considered.