Fracture Risk Assessment and Epidemiology
Development of Recommendations for Radiologists Regarding the Evaluation and Management of Osteoporosis When Reporting Major Osteoporotic Fractures in Those Over Age 50

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Aims

In Canada, 80% of fractures in women over the age of 50 are due to fragility, yet only 20% receive further investigation of possible underlying osteoporosis.1 The rate is even lower in men and in those in long term care.2,3 This is the postfracture care gap. Radiologists report these fractures but are often either reluctant to recommend or, more likely, never consider recommending further evaluation. It has been reported that when radiologists report vertebral fractures there is a positive

Methods

Following the publication of OC's 2010 Clinical Practice Guidelines for the diagnosis and management of osteoporosis in Canada, OC mandated a series of working groups focused on the highest risk patient. The group dedicated to health care professionals suggested that having radiologists identify patients whose fractures could be due to underlying osteoporosis and make directive recommendations regarding the evaluation and management of underlying osteoporosis could result in an increased rate

Results

A document was developed and published in the Canadian Association of Radiologists Journal5. It includes a reminder regarding the identification and reporting of incidental vertebral fractures as well as the following consensus wording: Hip / vertebral / proximal humerus / forearm (insert as appropriate) fractures in the absence of major trauma are associated with an increased future fracture risk due to underlying osteoporosis. Further evaluation and management is advised in accordance with

Conclusion

This collaborative process successfully developed consensus between CAR and OC's SAC regarding the reporting of fragility fractures and recommendations for evaluation and management of osteoporosis and could be applied in other jurisdictions.

References

  • 1.

    Bessette L et al Osteoporos Int 2008;19:79

  • 2.

    Papaioannou A et al Osteoporosis Int 2008;19:581

  • 3.

    Giangregorio L 0steoporosis Int 2009;20:1471

  • 4.

    Majumdar SR et al Am J Med 2012;125:929

  • 5.

    Burrell S et al Can Assoc Radiol J 2013;64:278

Acknowledgement

We would like to acknowledge the contributions of Ms K Grady from OC and Ms Andrea Nelson from CAR

Disclosure of Interest

None Declared

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