Colles' fractures and osteoporosis--A new role for the Emergency Department

Abstract

Purpose: In Denmark, guidelines from the Danish Orthopedic Society recommend that patients older than 65 years who sustain a Colles' fracture should be referred to assessment of underlying osteoporosis. An assessment of referral rates at our hospital during the period October 2010-September 2013 showed that none were referred. Due to this, an automatic out-patient referral system for assessment of underlying osteoporosis was established. With this system, patients are referred directly from the Emergency Department (ED). The purpose of this study was to assess how effective this new referral system was at improving referral rates for assessment of osteoporosis and to evaluate how many more cases of osteoporosis that was identified with this practice during the period October 2013-September 2014.

Method: The automatic referral system for evaluation of osteoporosis in patients 65 years and above without known osteoporosis, living in the catchment area and sustaining a low energy distal forearm fracture was established in October 2013. With the new system, patients were referred directly from the ED for evaluation of osteoporosis at the osteoporosis out-patient department at the hospital. The system was evaluated for the period October 2013-September 2014. For comparison data was collected on the same patient group for the 3 years preceding the system.

Results: Before the automatic system none were referred for evaluation of osteoporosis and thus none were diagnosed. After introduction of the system 100% were referred, 73.26% were examined and 65.08% of these were found to have osteoporosis. Anti-osteoporotic treatment was initiated in all but 4.88% of the patients.

Conclusion: The results show that this type of automatic referral system can be an effective way of increasing the number of patients diagnosed with and treated for osteoporosis. It also shows that involvement of the ED in the screening for osteoporosis can be an effective way of increasing referral rates leading to higher rates of diagnosed osteoporosis. The early identification and initiating of treatment might result in a lower rate of secondary and potentially more severe osteoporotic fractures.

Keywords: Colles fracture; Distal forearm fractures; Osteoporosis; Referral.