Osteoporosis, identification and treatment in fracture patients: An essential part of fracture management in elderly patients

Osteoporosis is a major health problem increasing the risk of sustaining a fragility fracture. The golden standard for diagnosing osteoporosis is the measurement of bone mineral density (BMD) with Dual Energy X-ray (DXA). The Dutch consensus on diagnosing osteoporosis is the screening of all fracture patients older than 50 years. Unfortunately, this is not achieved in about half the patients. In this thesis different aspects of the screening for osteoporosis are described in order to optimalize this. A vertebral fracture can be seen as proof for osteoporosis, independent of BMD. The prevalence of vertebral fractures in fracture patients over 50 years was 42%. That makes spinal imaging a useful first step in diagnosing osteoporosis. Patients with a distal radial fracture and osteoporosis are prone to malunion, early instability and late carpal malalignment. As no correlation was found between the AO- fracture classification system and BMD, the use of the AO classification for distal radial fractures as a reliable screening method is not feasible. The Calscan is another way of measuring BMD, besides DXA. It proved to be a valid measurement device, capable of classifying half the patients, so including the Calscan means that substantially more patients can be tested on osteoporosis.
It is also important to find underlying diseases which can cause osteoporosis. Research results showed that underlying diseases in fracture patients over 50 years were however uncommon. Based on subgroup analysis we recommend to screen only osteoporotic male patients on this possibility.