Australia is falling down in delivering hip fracture care and providing measures to prevent a secondary fracture once patients leave hospital, according to the latest report of the Australian and New Zealand Hip Fracture Registry.

An increasing number of older Australians are suffering hip fractures as the population ages, with the number expected to hit 30,000 a year by 2022 and a cost to the health system of more than $1 billion.

An estimated one in four men and two in five women aged 50 and over will experience a hip fracture, ANZHFR’s 2018 report, released on Thursday, shows.

Approximately 22,000 people over the age of 50 were hospitalised with a hip fracture in 2015-16.

A hip fracture is one of the most serious types of minimal trauma fracture and a quarter of older people will die within a year of sustaining the injury.

“Yet research shows that effective and efficient hip fracture care and secondary fracture prevention are not routinely delivered,” the ANZHFR report says.

“This care gap leaves hip fracture survivors with an increased risk of subsequent fall and fractures that are associated with increased mortality.”

Clinical care standards

According to clinical care standards developed by the Australian Commission on Safety and Quality in Health Care, hip fracture patients  should be offered a falls and bone health assessment and a management plan to avoid risk of another fracture before leaving hospital.

Professor Jacqueline Close

The report showed that 20 per cent of patients didn’t undergo a risk assessment during their stay, less than a quarter were getting bone protection medication on discharge and less than one in three were getting it 120 days afterwards.

Less than a third of hospitals provided written, individualised information describing ongoing care and recommendations for patients and their carers about preventing future falls and fractures.

The report also said that while dedicating resources to follow-up hip fractures has been shown to reduce re-fracture rates, the availability of fracture liaison services and outpatient clinics targeting secondary fracture prevention remains limited.

Osteoporosis plans

Australia was lagging behind other countries in providing osteoporosis plans for hip fracture patients leaving hospital,  ANZHFR chair Professor Jacqueline Close said.

She said all hip fracture patients should be given vitamin D supplements after leaving hospital and started on bone density treatments, or given a plan for them to follow up with a GP.

“The long-term management of chronic diseases sits with GPs and osteoporosis is chronic disease so longer term, it should sit with primary care,” Dr Close told a briefing at the release of the report.

“Financial incentives could help in the same way there are financial incentives for immunisation, which led to a marked increase.

“The commonwealth government should consider producing incentives for increasing the uptake of osteoporosis treatment after fracture.”

The findings have prompted NeuRA, where the registry is based, to release a hip fracture care guide for patients and their carers.

“Our goal is to highlight the current gaps in care and work with hospitals across Australia and New Zealand to increase the uptake of treatments for which we know there is evidence of benefit,” ANZHFR co-chair Professor Ian Harris said.

You can read the full report here.

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