Dementia and fragility fractures: Issues and solutions

Vun, Shen Hwa; Ahmadi, Milad; Panteli, Michalis; Pountos, Ippokratis; Giannoudis, Peter V.

doi:10.1016/j.injury.2017.08.031

Cited by 20 publications

(15 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These study findings have clinical implications for drug selection for dementia treatment. Dementia and fractures share a complex bidirectional relationship beyond the common impact of advancing age on their incidences . Dementia independently increases hip fracture risk 2.7‐fold .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia

Ogunwale

Colón‐Emeric

Sloane

et al. 2019

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Acetylcholinesterase inhibitors (AChEIs) have been noted to increase bone density and quality in mice. Human studies are limited but suggest an association with improved bone healing after hip fracture. We examined the relationship between AChEI use and fracture risk in a national cohort of 360,015 male veterans aged 65 to 99 years with dementia but without prior fracture using Veterans Affairs (VA) hospital, Medicare, and pharmacy records from 2000 to 2010. Diagnosis of dementia, any clinical fracture (excluding facial and digital), comorbidities, and medications were identified using ICD‐9 and drug class codes. Cox proportional hazard models considering AChEI use as a time‐varying covariate and adjusting for fall and fracture risk factors compared the time‐to‐fracture in AChEI users versus non‐AChEI users. Potential confounders included demographics (age, race, body mass index), comorbidities associated with fracture or falls (diabetes, lung disease, stroke, Parkinson's, seizures, etc.) and medications associated with fracture or falls (bisphosphonates, glucocorticoids, androgen deprivation therapy [ADT], proton pump inhibitors [PPIs], selective serotonin receptor inhibitors [SSRIs], etc.). Competing mortality risk was considered using the methods of Fine and Gray. To account for persistent effects on bone density or quality that might confer protection after stopping the medication, we completed a secondary analysis using the medication possession ratio (MPR) as a continuous variable in logistic regression models and also compared MPR increments of 10% to minimal/no use (MPR 0 to <0.10). Among older veterans with diagnosis of dementia, 20.1% suffered a fracture over an average of 4.6 years of follow‐up. Overall, 42.3% of the cohort were prescribed AChEIs during the study period. The hazard of any fracture among AChEI users compared with those on other/no dementia medications was significantly lower in fully adjusted models (hazard ratio [HR] = 0.81; 95% confidence interval [CI] 0.75–0.88). After considering competing mortality risk, fracture risk remained 18% lower in veterans using AChEIs (HR = 0.82; 95% CI 0.76–0.89). © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Dementia and fractures share a complex bidirectional relationship beyond the common impact of advancing age on their incidences. (32) Dementia independently increases hip fracture risk 2.7-fold. (33) Available study outcomes on the association between dementia and risk of fractures at other sites (wrist and vertebral) are inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia

Ogunwale

Colón‐Emeric

Sloane

et al. 2019

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

show abstract

“…The current guidance recommends early diagnosis and management of dementia. Similarly, guidance has been focused on the primary and secondary prevention of osteoporotic fractures to improve clinical outcomes and reduce healthcare cost and socioeconomic burden [ 26 , 36 , 37 ]. A combination of lifestyle changes and drug treatment has been proposed in order to treat patients with osteoporosis [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship of Prevalent Fragility Fracture in Dementia Patients: Three Years Follow up Study

et al. 2020

View full text Add to dashboard Cite

Introduction: dementia increases the risk of falls by 2–3 times and cognitively impaired patients are three times more likely to have hip fracture following a fall when compared to cognitively intact individuals. However, there is not enough evidence that explores the relationship between dementia and fragility fractures. The aim of this study is to explore the relationships of prevalent fragility fracture in patients with dementia admitted with an acute illness to the hospital. Methods: the existing Health Board records were reviewed retrospectively for all patients admitted diagnosed with dementia in the year 2016. All patients were followed up for a maximum of three years. All of the the dementia patients were divided into three groups: group 1—“no fractures”; group 2—“all fractures”; group 3—“fragility fractures”. Clinical outcomes were analysed for hospital stay, discharge destination (new care home), post-discharge hip fracture data, and mortality. Results: dementia patients with a prevalent fracture were significantly older, 62% were women. A significantly higher proportion of dementia patients with prevalent fractures were care home residents and taking a significantly higher number of medications. The mean Charlson comorbidity index was similar in patients with or without fracture. Dementia patients with a prevalent fracture required a new care home and this is significantly higher when compared to those with no fracture. Mortality at one year and three year was not statistically different in patients with or without prevalent fractures. A significantly higher number (21.5%) of dementia patients with prevalent fragility fracture sustained a new hip fracture when compared to those with no prevalent osteoporotic fracture (2.9%) over the three years follow up (p < 0.0001). Conclusion: dementia patients with a prevalent fragility fracture is associated with a statistically significant higher risk of a new care home placement following acute hospital admission. This sub-group is also at risk of a new hip fracture in the next three years. Whilst clinical judgement remains crucial in the care of frail older people, it is prudent to consider medical management of osteoporosis in dementia if deemed to be beneficial following the comprehensive geriatric assessment.

show abstract

“…Through the Mobile Outreach program, orthopedic care rendered includes postoperative hip fracture care, which can specifically bring the most appropriate care to this vulnerable patient population. 34 This may reduce postsurgical emergency department visits, readmissions, morbidity, mortality, as well as overall medical care costs. Work is underway to evaluate these potential care process outcomes.…”

Section: Discussionmentioning

confidence: 99%

Mobile Outreach: An Innovative Program for Older Orthopedic Patients in Care Facilities

Switzer

Schroder

2019

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction:The worldwide incidence of fragility fractures is increasing and the greatest burden is borne by the oldest population. Mobile Outreach, an innovative orthopedic-based program providing on-site musculoskeletal care for individuals in nursing care facilities, was implemented as part of our Geriatric Orthopaedic Trauma Program. The objectives of this report are to describe characteristics of patients cared for through Mobile Outreach and to report specific services provided.Program Description:Based from a nonprofit, private hospital that serves as the community’s level 1 trauma center and teaching hospital, the Mobile Outreach Program is directed by an orthopedic surgeon with geriatric subspecialization and staffed by a full-time geriatric nurse practitioner. Patients receive care for musculoskeletal concerns and fracture assessments at their nursing care facilities by a Mobile Outreach care provider. Referral for care is from nursing care facilities or as scheduled postoperative follow-up.Results:In 2016, the program treated 458 patients (76% female) in the patients’ care settings for a total of 689 visits. The mean age was 81 years (standard deviation = 14; range 25-107). Care of patients included nonoperative fracture care in 100 (22%), postoperative fracture follow-up in 149 (33%), injections for pain management in 184 (40%), and other orthopedic care in 25 (5%). Visits occurred at 88 facilities, mean 7 visits per site (range 1-57).Conclusions:Mobile Outreach was implemented to improve postoperative fracture care in the elderly patients. The program also provides on-site nonoperative fracture care and care of frail elderly individuals with chronic musculoskeletal conditions. This report aims to establish the feasibility of a program focused on the provision of appropriate, coordinated care for older fracture patients in their care facility. Level of Evidence: Level V.

show abstract

Dementia and fragility fractures: Issues and solutions

Cited by 20 publications

References 59 publications

Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia

Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia

Relationship of Prevalent Fragility Fracture in Dementia Patients: Three Years Follow up Study

Mobile Outreach: An Innovative Program for Older Orthopedic Patients in Care Facilities

Contact Info

Product

Resources

About