Secondary prevention of osteoporosis post minimal trauma fracture in an Australian regional and rural population.

OBJECTIVE: Minimal trauma fracture (MTF) is an indication of osteoporosis and risk of future fracture. Our objective was to describe osteoporosis risk identification and secondary prevention in a regional and rural population hospitalised for an MTF. DESIGN: A retrospective inpatient file audit and follow-up telephone interview. SETTING: Patients aged 45 years and over admitted for MTF management to two regional hospitals in northern New South Wales between July 2006 and June 2007. MAIN OUTCOME MEASURES: Proportion of patients who received bone mineral densitometry (BMD) assessment and proportion commenced on osteoporosis medication post fracture. RESULTS: There were 459 patients included in our inpatient file audit. During admission only 16% had osteoporosis risk documented, uptake of vitamin D assay or BMD were minimal and only 22% were discharged on preventive medication. Of 219 patients contacted post discharge, 36% reported discussing osteoporosis risk with their GPs, 22% reported post-discharge BMD and 32% were taking a bisphosphonate. Men were less likely to have commenced preventive medication (OR 0.42, CI, 0.19-0.91) and patients informed of their osteoporosis risk during hospitalisation were more likely to have had BMD (OR 1.93, CI, 1.03-3.61). Neither age nor history of previous MTF was predictive of preventive treatment post discharge. CONCLUSION: Overall, fracture risk identification and initiation of secondary prevention in this regional and rural population was low and this is consistent with findings in recent metropolitan studies. Effective regional and rural strategies are required that ensure identification and effective communication of risk to patients and their GPs.

Smoke free health care: an organisational change to increase effective intervention for tobacco.

In 1999, the NSW Health Smoke Free Workplace Policy directed that grounds of health sites would become smoke free, in addition to the existing policy requiring smoke-free buildings. This was one of the first attempts by any health service to exclude tobacco entirely from health sites. This task required the adoption of evidence-based management of tobacco dependence and changing the culture of smoking in the health service. There were many barriers to implementation.