Under-recognized, under-referred: a multidisciplinary evaluation of fragility fracture management in the emergency setting

Fragility fractures are frequently under-recognized in emergency departments. A survey of 34 professionals revealed inconsistent assessment of key risk factors. Relevant gaps emerged between awareness and routine practice across professional roles. These findings highlight opportunities to improve recognition, documentation, and secondary prevention in ED settings. PURPOSE: Fragility fractures are often under-recognized in the emergency setting, where the absence of standardized procedures leads to missed opportunities for diagnosis and secondary prevention. This project aimed to explore current emergency department (ED) practices regarding the identification and management of fragility fractures. METHODS: A qualitative, cross-sectional survey was conducted among 34 healthcare professionals (10 emergency physicians, 11 radiologists, and 13 emergency nurses) from various Italian regions. The questionnaire, developed by a multidisciplinary expert panel, investigated propensities and self-reported practices related to fracture assessment, risk factor identification, and diagnosis of fragility fracture. All responses were grouped by role and represented graphically. Findings were then discussed during an expert meeting with the same panel. RESULTS: Survey data revealed a generally high level of self-reported awareness of fragility risk factors among ED professionals but inconsistent implementation of the necessary diagnostic workup in daily practice. Important indicators, such as prior fractures, history of falls, family history of hip fracture, and use of risky medications, were often under-assessed. The term "fragility fracture" at discharge from the ED was rarely used, and role-based discrepancies emerged in risk assessment practices. CONCLUSION: This survey highlights relevant gaps between awareness and clinical practice in the identification of fragility fractures in the emergency setting. Improving consistency in risk assessment and documentation may represent a key step toward optimizing secondary prevention and standardizing fragility fracture management in EDs.