Effective Case-Finding of Osteoporosis in a Fracture and Osteoporosis Clinic in Groningen: an Analysis of the First 100 Patients

Zusammenfassung

Zielsetzung: Die Evaluation einer Osteoporose-Diagnostik in einer Fraktur- und Osteoporoseklinik (FO) bei Patienten ab dem 50. Lebensjahr mit Frakturen nach Niedrigenergietrauma. Design: Deskriptiv. Methode: Teilweise im Rahmen der revidierten CBO-Osteoporoseleitlinien, die im Jahr 2002 erschienen, wurde am Universitätshospital Groningen, Niederlande, eine FO-Ambulanz eröffnet. Nach initialer Unfallbehandlung wurde Patienten ab dem 50. Lebensjahr mit Frakturen nach Niedrigenergietrauma eine weitergehende Diagnostik und Behandlung in dieser Spezialklinik angeboten. Die Knochendichte im Bereich der Lendenwirbelsäule, der Hüfte und des distalen Radius wurde mittels dual energy X-ray absorptiometry (DEXA) bestimmt. Patienten mit manifester Osteoporose, definiert als Fraktur bei T-Score ≤ - 2 SD an einem der Messorte, wurden medikamentös behandelt. Die Ergebnisse der ersten 100 Patienten wurden ausgewertet. Ergebnisse: Innerhalb der ersten 5 Monate wurden 74 % (116/156) der Patienten an die FO-Ambulanz überwiesen. Mitte Januar 2004 war die Diagnostik bei den ersten 100 Patienten vervollständigt: 67 Patienten hatten manifeste Osteoporose, 20 hatten Osteopenie und 13 hatten eine normale Knochendichte. 48 % der Patienten im Alter zwischen 50 und 60 Jahren hatten manifeste Osteoporose. Zuvor unbekannte osteoporotische Wirbelfrakturen wurden bei 21 Patienten gefunden. 43 % der Patienten mit manifester Osteoporose hatten verringerte 25-OH-Vitamin-D-Level (< 30 nmol/l). Elf Patienten wurden wegen Anzeichen einer sekundären Osteoporose der Abteilung für innere Medizin überstellt. Schlussfolgerung: Die spezielle FO-Ambulanz hat sich zur Diagnostik und Behandlung einer Patientengruppe mit erhöhtem Risiko für Osteoporose als effizient und nützlich erwiesen.

Abstract

Objective: To evaluate osteoporosis case-finding at a Fracture and Osteoporosis (FO) Clinic in patients aged 50 years and older with fractures due to low-energy trauma. Design: Descriptive. Method: Partly in response to the revised CBO osteoporosis guidelines which appeared in 2002, an FO Outpatient Clinic was opened at University Medical Centre of Groningen in the Netherlands. After initial treatment for trauma, patients of 50 years and older who came to the Central Emergency Department with fractures resulting from low-energy accidents were offered further diagnosis and treatment at this special clinic. Bone mineral density of the lumbar spine, hip and distal radius was measured using dual energy X-ray absorptiometry (DEXA). Patients with manifest osteoporosis, defined as having a fracture and a T-score ≤ - 2 SD at one of the sites measured, were put on medication. The results from the first 100 patients were analysed. Results: In the first five months 74 % (116/156) of the patients were referred to the FO Outpatient Clinic. By mid-January 2004 the first 100 patients had completed the diagnostic procedure: 67 of them had manifest osteoporosis, 20 osteopenia and 13 had normal bone density. Moreover, 48 % of the patients between 50 and 60 years had manifest osteoporosis. Previously undetected osteoporotic vertebral fractures were found in 21 patients. Forty-three percent of patients with manifest osteoporosis were found to have low 25-OH-vitamin D levels (< 30 nmol/l). Eleven patients were referred to the Department of Internal Medicine because of indications of secondary osteoporosis. Conclusion: The special FO Outpatient Clinic proved to be effective and useful in identifying and treating a population with an increased risk of osteoporosis.

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