Worse health outcomes for at-risk patients with fractures

People at high risk for fractures who also have complex or multiple chronic medical conditions are less likely to receive treatment for underlying osteoporosis and also have worse health outcomes, according to a new study from the Garvan Institute of Medical Research.

These patients have an increased risk of further fractures, but are less likely to have the underlying cause of the fracture investigated, than those who are at high risk but have no additional chronic conditions.

“Regardless of the site of the fracture, we believe the fracture is of insufficient priority in the clinical setting in a complex patient,” says lead author Dr. Dana Bliuc, Senior Research Officer at Garvan’s Clinical Studies and Epidemiology Lab.

“People with complex illnesses not only fare worse, but are less likely to receive treatment, which is a double whammy. We think this is because fractures are considered less serious than other medical conditions present in patients, and so they are not the focus of intervention,” says Dr. Bliuc. “But the fracture itself will affect quality of life and contribute to mortality.”

The findings will help provide new guidelines on how fractures in patients with complex medical conditions are studied and treated by physicians.

The new study is published in the journal PLOS medicine.

Fractures from falls and mishaps, rather than trauma such as motor vehicle accidents, occur in about one in three women and one in five men over the age of 50.

To study the outcomes and type of medical treatment people with these fractures receive, researchers studied the prescriptions, Medicare applications and hospitalization data of more than 10,500 Australian patients over the age of 45, identified as being at high risk. of a future fracture.

They found that in patients in the high-risk group, more than 80% of people were not treated for osteoporosis to prevent future fractures when they should have been, and this decreased even more for patients with complex medical conditions. .

“We need to start shifting our paradigm of how we think about disease and treatment to be less of a ‘single disease-single treatment’, to treat the person as a whole,” says Professor Jacqueline Center, Head of Clinical Trials and Laboratory of epidemiology in Garvan.

“Our goal is to improve the health of older people, so that people are living well, rather than just living.”