| BGS
Newsletter Online |
| Fragility fractures |
| Email your comments Fragility fractures make up the majority of the 310,000 UK patients who fracture each year. Around a quarter are hip fractures, for which demography and a rising age-specific incidence are leading to an overall 2% increased incidence per annum. Subsequent mortality is high, about five-fold compared to their peers without fractures in the following 12 months. These hip fractures account for direct healthcare costs of £1.8 billion per annum, estimated to reach £2.2 billion by 2020. As much again results from the social care costs, associated with incomplete functional recovery. About half of patients experiencing a hip fracture have had a previous fragility fracture of the wrist, upper arm or pelvis, usually after a fall. These fractures also contribute significant pain, disability and health and social care costs. The most effective strategy to prevent future hip fractures is likely to be based on reducing the future risk of falling of those people who have a first fragility fractures or other injury and present to hospital Accident and Emergency departments. BUT up to a half of these have osteoporosis as well and therefore a combined falls and bone health approach is needed. Current evidence-based recommendations for preventing falls include regular strength and balance training, taking Vitamin D and Calcium supplements, medication modification and removal of hazards in the homes of at-risk people. These measures can reduce falls but much more needs to be done to ensure that high risk people have adequate assessments and treatments. The recent national audit from the Royal College of Physicians shows that less than half of such patients subsequently receive any treatment to prevent falls or fractures. There should be no further delay in ensuring comprehensive application by the NHS of the current NICE guidance on falls (CG21, 2004) and secondary treatment of osteoporosis (Technology Appraisal guidance 87, 2005). David Marsh, Professor of Clinical Orthopaedics |