Clin Orthop Surg.  2016 Sep;8(3):274-279. 10.4055/cios.2016.8.3.274.

The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures

• Kim TI
• Choi JH
• Kim SH
• Oh JH

• KMID: 2374273
• DOI: http://doi.org/10.4055/cios.2016.8.3.274

Abstract

BACKGROUND
The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures.
METHODS
A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 years of age, the frequencies of diagnostic bone density scan for osteoporosis, and the prescription for the osteoporosis medication were analyzed and compared.
RESULTS
A search of database identified 48,351 hip fractures, 141,208 spine fractures, and 11,609 proximal humeral fractures in patients more than 50 years of age in 2010. Among these patients, 12,097 (25.0%) of hip fractures, 41,962 (29.7%) of spine fractures, and 1,458 (12.6%) of proximal humeral fractures underwent diagnostic bone density scan (p < 0.001); 4,773 (9.9%) of hip fractures, 27,261 (19.3%) of spine fractures, and 639 (5.5%) of proximal humeral fractures were managed with at least one medication approved for the treatment of osteoporosis (p < 0.001). Furthermore, 1,217 (2.5%) of hip fractures, 7,271 (5.2%) of spine fractures, and 188 (1.6%) of proximal humeral fractures received diagnostic bone density scans as well as osteoporosis medications (p < 0.001). Younger patients (50-69 years of age) were less likely to be evaluated and managed for osteoporosis relative to older patients (≥ 70 years of age) (p < 0.001); and men were less likely to be evaluated and managed for osteoporosis relative to women (p < 0.001).
CONCLUSIONS
Current physicians' practice pattern may be inadequate for the diagnosis and treatment of osteoporosis in patients of proximal humeral fractures over the age of 50 years. Additional study and educational programs are necessary to improve this care gap, beginning with physicians who are responsible for the fracture treatment and shoulder diseases.

Keyword

Proximal humeral fracture; Osteoporosis; Diagnosis; Treatment

MeSH Terms

Aged
Bone Density
Bone Density Conservation Agents/therapeutic use
Female
Humans
Male
Middle Aged
*Osteoporosis/complications/diagnosis/drug therapy/epidemiology
Retrospective Studies
Shoulder Fractures/*complications/*epidemiology
Bone Density Conservation Agents

Figure

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  Fig. 1 Comparison of the incidence rate (per 100,000) of hip, spine, and proximal humeral fractures among persons older than 50 years of age in Korea in 2010.

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  Fig. 2 The percentage of screened group, treated group, and the group receiving screen test and treatment simultaneously according to the fracture site.

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  Fig. 3 Comparison of rate of patients receiving screen test and treatment simultaneously for osteoporosis after fracture with using incidence ratio rate.

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