Bone health assessment in adults with fragility fracture risk factors between 2002-2014: a retrospective cohort study

Background Lifetime risk of fragility fractures is 50% in post-menopausal women and 20% in men aged over 50 years. Identifying people at high risk facilitates early intervention and reduction of biopsychosocial morbidity associated with these fractures.

Aim To explore if bone health assessment (BHA) rates differ between women and men aged 50 years and over with fragility fracture risk factors.

Design & setting A primary care-based cohort study

Method Patients were identified from the Consultations in Primary Care Archive (CiPCA) database between 2002 and 2014 with one or more fragility fracture risk factors (previous fractures, falls and prolonged steroid use). Evaluation of BHA within twelve months of presentation of the first risk factor was carried out by searching for codes for fracture risk assessment tools (FRAX/QFracture), bone density measurement, specialist service referral or if bone-protection medication was started.

Results 15,581 patients with risk factors were identified; men represented 40% of the cohort. 1,172 (7.5%) had BHA performed within one year of presentation. 8.9% of females and 5.5% of males had BHAs, which was found with strong statistical evidence (X²=59.88, P=1 × 10^-14). This relationship prevailed after adjusting for other covariates such as co-morbidity and number of consultations with an odds ratio of 1.25 (95% Confidence Interval 1.08–1.43).

Conclusion This study shows that rates of BHA were generally low and even lower in men. Primary care clinicians should be alert to fragility fracture risk factors in both men and women to enable early assessment and intervention.