A number of patients with a minimal trauma fracture may not present to a hospital, whereas almost all patients with a minimal trauma fracture will eventually see their primary care physician (although, it should be noted, not necessarily for a minimal trauma fracture). Therefore, the primary care physician is key to ensuring patients are appropriately managed after a minimal trauma fracture. Furthermore, SFP programs primarily capture patients with non-hip, non-vertebral fractures and thus will not capture all patients at high risk of fracture or re-fracture, such as those with vertebral body fracture, frail elderly, those in institutionalised care and those with hip fractures managed via orthopaedic pathways.40 Ortho-geriatric services, which are now present in most Australian hospitals, are critical to addressing this deficit. Potentially more importantly, primary care physicians need to be adequately equipped to detect and manage osteoporosis. The latter is being achieved through initiatives such as SFP in primary care and HealthPathways.
A recent systematic review of ortho-geriatric models of care, covering 18 (mainly retrospective cohort) studies from 1992 to 201241 demonstrated a reduction in in-patient and long-term (6–12 months post-fracture) mortality (relative risk [RR]: 0.60, 95% confidence interval [CI]: 0.43–0.84 and RR: 0.83, 95% CI: 0.74–0.94, respectively). Length of stay was reduced in the ortho-geriatric care model. A number of important outcome measures were not reported in many of these studies, such as delirium, functional status, post-discharge destination of patients, time to surgery, complications post-surgery, institution of falls risk assessment, measures to reduce falls risk, institution of measures aimed at secondary fracture prevention.
The treatment gap in osteoporosis care in Australia can be addressed through implementation of SFP programs and ortho-geriatric services in both the hospital and primary care setting. Supporting primary care physicians to manage osteoporosis in patients who do not have access to these programs is critical to ensuring that all patients with a minimal trauma fracture are evaluated and managed appropriately.