People with multiple chronic conditions who are also at risk of bone fracture are not likely to be investigated or treated for osteoporosis, according to a new study from the Garvan Institute of Medical Research using 45 and Up Study data.
The study, published in the journal PLOS Medicine, found that the more chronic conditions a person has, the less chance they have of being considered for osteoporosis after they experience a bone fracture. A person with four or more chronic conditions is up to 57% less likely to be tested for osteoporosis and up to 65% less likely to be treated for osteoporosis, compared with someone who has one or no chronic conditions.
Researchers looked at 10,000 people from the 45 and Up Study who experienced a bone fracture between 2005 and 2017. Participants were all considered high-risk for future fracture, based on factors including their age, sex and history of prior falls or fractures, and were not being treated for osteoporosis at the time of their fracture. Only bone fractures that are typically associated with osteoporosis were included in the analysis. Participants were relatively healthy, with less than 40% having two or more chronic conditions.
Overall, 22% of women and 14% of men were put on osteoporosis medication after a bone fracture, and just 17% of females and 7% of men were given a referral for a bone-density scan. Those rates dropped even lower as the number of chronic conditions a person had rose.
“No matter the fracture site, we believe fracture is under-prioritised in the clinical setting in a complex patient,” says lead author Dr Dana Bliuc, Senior Research Officer in the Clinical Studies and Epidemiology Lab at the Garvan Institute of Medical Research.
“People with complex diseases not only fare worse, but they are less likely to receive treatment, which is a double whammy. We think this is because fractures are viewed as less serious than other medical conditions present in patients, and thus not the focus of intervention. But fracture itself will affect quality of life and contributes to mortality.”
Certain chronic conditions lessened people’s chance of testing or treatment. Type 2 diabetes on its own was linked to lower odds of osteoporosis investigation and treatment in both women and men. The study authors theorised that “the higher BMI and implicitly higher bone density often encountered in people with diabetes may contribute to the perception that they have a lower fracture risk” or that the higher treatment burden for patients with diabetes may reduce the prioritisation of fracture.
Dementia was also found to lessen the odds of investigation and treatment in women, which has been reported in previous research. Men in general received less testing and medication for osteoporosis than women, and this disparity increased with the number of chronic conditions.
The research will help inform new guidelines for how fractures in patients with complex medical conditions are investigated and treated by clinicians.
