Investigation and treatment rates following minimal trauma fracture: results of a primary care physician survey

Background Primary care plays a critical role in osteoporosis prevention and management. As part of a larger randomised controlled trial involving patients who had sustained a potential osteoporotic fracture, we asked general practitioners (GPs) about their perspectives on secondary fracture prevention. Methods The INTERCEPT trial, a cluster-randomised controlled trial, identified patients with potential minimal trauma fractures and alerted the patients’ GPs to the fracture, along with best-practice guidelines for osteoporosis management. Four weeks following the alert, a survey assessed the GPs’ views and decisions on osteoporosis-directed investigations and treatments. Results Out of 170 responses, GPs considered 76 (44.7%) fractures as minimal trauma, 60 (35.3%) as not minimal trauma, and 34 (20%) as uncertain. Fractures were more likely to be considered minimal trauma if they involved the spine or if patients were older and/or female. A significant number of patients were not investigated or treated for osteoporosis despite the GP considering the fracture minimal trauma: only 44 of these 76 (57.9%) patients had a DXA (dual energy X-ray absorptiometry) scan, and less than half (n = 34) were commenced on osteoporosis-directed treatment. DXA T-scores above −2.5 s.d. or awaiting confirmation via a DXA scan were common reasons for not initiating treatment despite regarding the fracture as minimal trauma. Conclusion Rates of osteoporosis-directed investigations and treatment after minimal trauma fractures in primary care are below recommended levels. There remains a gap between observed management practices and established guidelines. A major barrier appears to be the reliance on DXA for confirmation of osteoporosis despite the presence of a minimal trauma fracture.