Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management.

We determined to survey the general practice population regarding their attitudes to and knowledge of osteoporosis as a baseline prior to publication of national guidelines for the management of osteoporosis. All 2515 general practitioners registered in the 10 Health Authorities of the North Thames region, London, UK were surveyed by a postal questionnaire. Responses relating to epidemiology, public health and education on osteoporosis were analyzed. The overall response was 1153 (46%). General practitioners who responded were younger, predominantly female and in group practice. There is considerable awareness of the importance of preventing osteoporosis. General practitioners are active in identifying groups at risk, particularly those who are aged 40 years and older. A prevention strategy for osteoporosis is viewed as effective. However, two thirds of general practitioners remain unconvinced about the efficacy of drug therapy. Education on osteoporosis is considered inadequate. General practitioners would welcome further information on management issues and access to osteoporosis services. In conclusion, educational initiatives will be important both at undergraduate and postgraduate levels to increase awareness and knowledge of osteoporosis. General practitioners are aware of the public health impact of this condition and express a preference for educational material of direct relevance to the care of their patients. Therefore better cooperation between primary and secondary care should lead to ways of breaking down barriers to change in clinical practice and promoting fully integrated care of patients with osteoporosis.

Trends in hospital admissions for fractures of the hip and femur in England, 1989-1990 to 1997-1998.

BACKGROUND: Fractures of the hip are a major public health issue. Suggestions of a recent stabilization of age-specific admission rates would have implications for health service planning, thus we investigated this using hospital data. METHOD: Hospital episode statistics for England, 1989-1990 to 1997-1998, were examined for admissions and deaths for fractures of the hip and femur in NHS hospitals in patients aged 45 years and over. RESULTS: Age-standardized admission rates increased by 32 per cent between 1989-1990 and 1997-1998 in men, and by 30 per cent in women. The increase in admission rates was almost entirely confined to the period 1989-1990 to 1991-1992, with very little change after this. The proportion of admissions ending in death during the study period decreased in both men (-35 per cent) and women (-40 per cent) but this change was largely confined to the early years of the study. The number of admissions from hip and femoral fractures in people aged 65 years and over is projected to increase from about 57,300 in 1997-1998 to 69,500 by 2021-2022. CONCLUSIONS: Age-specific rates of admission appear to be stabilizing, which is in contrast to previous trends. The lack of any decrease in hospital admission and mortality rates over the last 5 years is of concern. The management of osteoporosis-induced fractures in hospitals, the prevention and treatment of osteoporosis in primary care and the prevention of falls should be seen as priorities for the NHS to help reduce the burden of disease from osteoporosis in the elderly.