Assessment of clinical risk factors for osteoporosis in patients with consisted fracture Author: Roxana Costache, 5 th year student, General Medicine Coordinators: Associate Professor Ionela Pascanu and Professor Tiberiu Bataga

Fracture Bone fragility Osteoporosis Low Bone massMicroarchitectural deterioration

A fragility fracture is defined as a fracture that occurs spontaneously or following a minor trauma, such as a fall from standing height or a height less than a meter, a fall from sitting or a fall from laying down less than a meter high, a fall after having missed one to three steps.

Despite the availability of diagnosis modalities, effective treatments, and adequate health care assessments, there is a substantial care gap in the management of osteoporosis.

Consisted fracture Mortality Morbidity Institutionalization Economic costs Hospitalization

Objective:

Material and Method Retrospective Study 100 consecutive cases of consisted fracture Orthopedic I Clinic – Emergency County Hospital of Targu-Mures, Romania Retrospective Study 100 consecutive cases of consisted fracture Orthopedic I Clinic – Emergency County Hospital of Targu-Mures, Romania Evaluation of the clinical risk factors for an osteoporotic fracture FRAX® Tool – WHO

Results In the study group age ranged between 40 and 90 years old, 57% of patients were women, and the remaining men.

After introducing the patients’ data into the questionnaires, we calculated their risk with the help of the ‘Guideline for the diagnosis and management of osteoporosis’ published by University of Sheffield.

Low risk patients should only be reassured. Medium risk patients should perform a complete biochemical evaluation and a DXA scan for bone mineral density determination. For those with a high risk for a fragility fracture it is highly recommended to start specific antiosteoporotic treatment.

The calculated risk of developing a major fragility fracture in the next 10 years, for the men group, are:

The calculated risk of developing a major fragility fracture in the next 10 years, for the women group, are:

Discussions The questionnaire field “Parent fracture hip” was impossible to fill in, and by checking the “No” box at all the patients, we miscalculated and underestimated the factor risk, knowing that glucocorticoids and the genetic factor have the biggest influence on the questionnaire results.

Discussions None of the patients diagnosed with osteoporosis weren’t undergoing any antiosteoporotic treatment or a Vitamin D/Calcium supplementation, not even those who have had a previous (hip) fracture.

Conclusion We discovered a considerable percentage of patients with a medium or high risk of developing a major fracture in the next 10 years, which means that the consisted fracture could have been an osteoporotic one.

Recommendation Clinicians should undertake a thorough clinical investigation to identify the cause of weakened bones, educate the patient to recognize the consequences of bone fragility and fracture and offer appropriate treatment. Orthopedic charts - FRAX® questionnaire and the treatment initiated immediately as the diagnostic is confirmed and the high risk revealed. Prevention of the fracture cascade, once the first fracture is consisted.

Bibliography ‘The care gap in diagnosis and treatment with a fragility fracture’ © International Osteoporosis Foundation (L. Bessette) ‘Effective initiation of Osteoporosis Diagnosis and Treatment for Patients with a Fragility Fracture in an Orthopedi Environment’ (Earl R. Bogoch MD) ‘Journal of bone and mineral research’, Vol. 9, Number 8, 1994 ‘Guideline for the diagnosis and management of osteoporosis ‘, Sheffield University