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  GUIDELINES  FOR PREVENTION & TREATMENT            BACKGROUND             RESEARCH

BACKGROUND  TO THIS SERVICE

In its consultation document Our Healthier Nation (1998) the government identifies preventing accidents as one of four priorities for improving the nations health. The target is to reduce accidents by at least a fifth by the year 2010.

Falls leading to accidents are an important part of the burden of accidents.

Reducing accidents and, in particular hip fractures, is a major health care priority of the government with health authorities and primary care groups being encouraged to include it as a priority in their own health improvement programmes (Tessa Jowell 1998).  

A doctor shall render to his patients all necessary and appropriate personal medical services of the type usually provided by general practitioners.  …… a doctor shall order any drugs or appliances which are needed for the treatment of any patient for whom he is providing treatment. (Para 12 & 43, GP’s Terms of Service).

CURRENT COSTS OF FRACTURE

Osteoporotic fractures cost the NHS £942 million each year, 87% of which is attributed to hip fractures.

The average cost in the UK of managing one hip fracture case is about £12,000.

Over the last 30 years the age specific incidence of hip fractures has doubled.

Projected costs are expected to double again in the next 30 years.

MORTALITY AND MORBIDITY ASSOCIATED WITH HIP FRACTURES

Amongst all survivors of hip fracture 50% will have impaired ability to walk and between 25-50% will become more dependent on their carers. Many of these will require residential of nursing home care.

Excess mortality one year after fracture is 15-20%.

Five years after fracture and diagnosis the relative mortality rate is 17% in hip fracture compared with 0% in forearm fractures.

GOVERNMENT RECOMMENDATIONS

1994           Advisory Group on Osteoporosis.

1999          Royal College of Physicians Guidelines on the Treatment and Management of Osteoporosis.

  Both initiatives recommend that Health Authorities should purchase Bone Densitometry measurement for the management of osteoporosis.

  CAN WE DO ANYTHING ABOUT IT?

Answer: Yes – DXA and calcaneal ultrasound both identify patients with osteoporosis. Both have proved that they are predictive of future fracture in prospective Randomised Controlled Trials.

-        Use of high dose calcium and vitamin D supplements has been shown to reduce hip fractures by 43% at 18 months in elderly subjects.

-        Second generation bisphosphonates can reduce  fractures at all sites by about 55% at 3 years.

-        HRT is associated with decreased risk of fracture and decreased risk of falling.

-        Hip fracture protectors prevent fracture in elderly fallers.

Therefore it has become clear over the last decade, especially over the last 5 years, that there is real opportunity to make health gains.

    Currently in our district, there are in excess of 400 hip fractures per year.