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Fragility fracture care gap at a tertiary teaching hospital in Malaysia

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Abstract

Summary

Fracture begets fracture, pharmacological treatment is needed to prevent secondary fractures. This study found that there was a fragility fracture care gap where both bone health investigations and treatment initiation rates were low. Strategies such as Fracture Liaison Service is needed to address the care gap.

Purpose

This study aimed to investigate the clinical burden and secondary fracture prevention of fragility fractures at a tertiary teaching hospital in Malaysia.

Methods

Electronic medical records of all patients admitted with fragility fractures between 1 January 2017–31 December 2018 were reviewed. Patients < 50 years old, with non-fragility fractures, restricted access to medical records, transferred to another hospital or who passed away during admission were excluded. Descriptive statistics were used to summarise patients’ characteristics, frequency of fragility fractures, and secondary fracture prevention details. Binomial logistic regression was performed to analyse predictive factors for post-fracture bone health assessments and treatment initiation.

Results

1030 patients [female (767/1030, 74.5%)] presented with 1071 fractures [hip fractures (378/1071, 35.3%)]. 170/993 (17.1%) patients were initiated on anti-osteoporosis medications (AOMs) and 148/984 (15.0%) had bone mineral density (BMD) performed within 1-year post-fracture. Less than half (42.4%) of the patients remained on treatment at 1-year post-fracture. Older patients [65–74 years old: odds ratio (OR) = 2.18, 95%CI 1.05–4.52, p = 0.04; ≥ 75 years: OR = 3.06, 95%CI 1.54–6.07, p < 0.01], hip fractures (OR = 1.95, 95%CI 1.23–3.11, p < 0.01), Chinese ethnicity (OR = 1.90, 95%CI 1.07–3.35, p = 0.03),previously diagnosed with osteoporosis (OR = 2.65, 95%CI:1.32–5.31, p < 0.01) and a BMD test performed (OR = 12.48, 95%CI 8.04–19.37, p < 0.01) were found to have higher AOM initiation. Patients with past diagnosis of osteoporosis (OR = 4.45, 95%CI 2.25–8.81, p < 0.01) and initiated on AOM (OR = 11.34, 95%CI 7.57–16.97, p < 0.01) had a higher likelihood to undergo BMD testing.

Conclusion

The AOM initiation and BMD testing rates were low. There is a need to address the fragility fracture care gap with strategies such as Fracture Liaison Service.

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Data Availability

The data supporting this study's findings are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank May Hun Tai for her help in data collection.

Funding

There was no funding for this study.

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Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Min Hui Cheah, Hui Min Khor, Jeyakantha Ratnasingam & Terence Ong

  2. Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Pauline Siew Mei Lai

  3. Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    C. Sankara Kumar Chandrasekaran & Simmrat Singh

  4. Academic Unit Trauma and Emergency, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Mohd Idzwan Bin Zakaria

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  1. Min Hui Cheah
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Contributions

MHC, PSML, and TO contributed to the conception, design, acquisition of data, analysis, interpretation, revision, and final approval of the manuscript. HMK, JR, CSKC, SSJS and MIBZ contributed to the manuscript's interpretation, revision, and final approval. All authors have agreed to be accountable for all aspects of the work and are committed to the integrity/accuracy of the data reported.

Corresponding author

Correspondence to Terence Ong.

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Conflict of interest

Author PSML, HMK, JR, CSKC, SSJS and MIBZ declare that they have no financial interests. Author MHC has received a scholarship from the Faculty of Medicine Postgraduate Scholarship Scheme, University of Malaya. Author TO has received speaker and consultant honoraria from Company Amgen.

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Cheah, M.H., Lai, P.S.M., Khor, H.M. et al. Fragility fracture care gap at a tertiary teaching hospital in Malaysia. Arch Osteoporos 18, 63 (2023). https://doi.org/10.1007/s11657-023-01256-4

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