Follow-up for osteoporosis in older patients three years after a fracture

Background: Recently a Fracture and Osteoporosis outpatient clinic (FO clinic) was set up at the University Medical Centre Groningen (UMCG) with the aim to optimise case-finding of osteoporosis in older patients with a low-energy fracture. To provide a diagnostic setting before the start of our FO clinic, case-finding was carried out in patients who suffered an `osteoporotic' fracture in the year prior to the foundation of the FO clinic. During a three years follow up project, osteoporotic patients who needed therapy were identified. Methods: Patients aged >= 50 years who were seen in the UMCG for a low-energy fracture (shoulder, wrist or hip) one year before that period were asked to participate. The study was carried out in two parts - a telephone questionnaire and measurement of the bone mineral density (BMD). The data were compared with the results of the FO clinic. Results: Of the 191 patients, 88 could be contacted and were analysed. Of these 88 patients only 12 had undergone additional investigations for the presence of osteoporosis in the year of the fracture, and only six patients were on antiosteoporosis medication; 45 patients had already suffered an earlier fracture and ten had a more recent subsequent fracture. Measurements three years after their fracture revealed that 55% of the 88 patients had osteoporosis (T-score less than -2.5 SD). Conclusion: After a fracture, case-finding for osteoporosis is good clinical practice. In our study more than half of the patients were lost for follow-up after three years. But it is still worthwhile to check whether patients with fractures in the past had the necessary diagnostics and proper therapy. Comparing these results with those of the FO clinic, it is evident, however, that case-finding of osteoporosis after a fracture can be organised most effectively at the location where the patient first attends for treatment of the fracture, namely in the emergency department of the hospital.