Hip fracture patients are not treated for osteoporosis: A call to action

Harrington, J. Timothy; Broy, Susan B.; Derosa, Angela M.; Licata, Angelo A.; Shewmon, D. Alan

doi:10.1002/art.10787

Cited by 146 publications

(80 citation statements)

References 24 publications

(15 reference statements)

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“…We began our improvement project by studying osteoporosis care in hip fracture patients because they have a high risk of additional fractures and were believed to be a small accessible subpopulation. A retrospective baseline study indicated that only 5% of 1999 hip fracture patients were referred for DXA or treated with an antiresorptive drug either before or after their fracture (8).…”

Section: Resultsmentioning

confidence: 99%

“…In our own health system (University of Wisconsin Medical Foundation [UW]), only 5% of patients who sustained a hip fracture in 1999 were provided DXA and bisphosphonate treatment, either before or after their fracture, and few patients were being referred for DXA because of other fragility fractures (8). In 2000, we began an improvement project to address this deficiency.…”

Section: Introductionmentioning

confidence: 99%

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Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Harrington¹,

Barash²,

Day³

et al. 2005

Arthritis & Rheumatism

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Objective. To develop new processes that assure more reliable, population-based care of fragility fracture patients. Methods. A 4-year clinical improvement project was performed in a multispecialty, community practice health system using evidence-based guidelines and rapid cycle process improvement methods (plan-do-study-act cycles). Results. Prior to this project, appropriate osteoporosis care was provided to only 5% of our 1999 hip fracture patients. In 2001, primary physicians were provided prompts about appropriate care (cycle 1), which resulted in improved care for only 20% of patients. A process improvement pilot in 2002 (cycle 2) and full program implementation in 2003 (cycle 3) have assured osteoporosis care for all willing and able patients with any fragility fracture. Altogether, 58% of 2003 fragility fracture patients, including 46% of those with hip fracture, have had a bone measurement, have been assigned to osteoporosis care with their primary physician or a consultant, and are being monitored regularly. Only 19% refused osteoporosis care. Key process improvements have included using orthopedic billings to identify patients, referring patients directly from orthopedics to an osteoporosis care program, organizing care with a nurse manager and process management computer software, assigning patients to primary or consultative physician care based on disease severity, and monitoring adherence to therapy by telephone. Conclusion. Reliable osteoporosis care is achievable by redesigning clinical processes. Performance data motivate physicians to reconsider traditional approaches. Improving the care of osteoporosis and other chronic diseases requires coordinated care across specialty boundaries and health system support.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Harrington¹,

Barash²,

Day³

et al. 2005

Arthritis & Rheumatism

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“…For patients in whom the baseline serum 25-hydroxyvitamin D level was 40 ng per milliliter or less, a loading dose of 50,000 to 60,000 IU of vitamin D was administered at the time the trial regimen was started. All patients received daily calcium (500 to 1000 mg) and vitamin D 3 or D 2 (600 to 800 IU).…”

Section: Patientsmentioning

confidence: 99%

“…1,2 Even after a fracture, fewer than 25% of patients receive pharmacologic treatment for osteoporosis. [3][4][5] After the discovery that sclerostin deficiency causes rare genetic conditions that are characterized by high bone mass and resistance to fracture, 6,7 sclerostin became a therapeutic target for the treatment of osteoporosis. Sclerostin, a negative regulator of bone formation that is secreted by osteocytes, 8 inhibits Wnt signaling, down-regulating this stimulus for osteoblast development and function.…”

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confidence: 99%

Romosozumab Treatment in Postmenopausal Women with Osteoporosis

et al. 2016

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BACKGROUNDRomosozumab, a monoclonal antibody that binds sclerostin, increases bone formation and decreases bone resorption. METHODSWe enrolled 7180 postmenopausal women who had a T score of -2.5 to -3.5 at the total hip or femoral neck. Patients were randomly assigned to receive subcutaneous injections of romosozumab (at a dose of 210 mg) or placebo monthly for 12 months; thereafter, patients in each group received denosumab for 12 months, at a dose of 60 mg, administered subcutaneously every 6 months. The coprimary end points were the cumulative incidences of new vertebral fractures at 12 months and 24 months. Secondary end points included clinical (a composite of nonvertebral and symptomatic vertebral) and nonvertebral fractures. RESULTSAt 12 months, new vertebral fractures had occurred in 16 of 3321 patients (0.5%) in the romosozumab group, as compared with 59 of 3322 (1.8%) in the placebo group (representing a 73% lower risk with romosozumab; P<0.001). Clinical fractures had occurred in 58 of 3589 patients (1.6%) in the romosozumab group, as compared with 90 of 3591 (2.5%) in the placebo group (a 36% lower risk with romosozumab; P = 0.008). Nonvertebral fractures had occurred in 56 of 3589 patients (1.6%) in the romosozumab group and in 75 of 3591 (2.1%) in the placebo group (P = 0.10). At 24 months, the rates of vertebral fractures were significantly lower in the romosozumab group than in the placebo group after each group made the transition to denosumab (0.6% [21 of 3325 patients] in the romosozumab group vs. 2.5% [84 of 3327] in the placebo group, a 75% lower risk with romosozumab; P<0.001). Adverse events, including instances of hyperostosis, cardiovascular events, osteoarthritis, and cancer, appeared to be balanced between the groups. One atypical femoral fracture and two cases of osteonecrosis of the jaw were observed in the romosozumab group. CONCLUSIONSIn postmenopausal women with osteoporosis, romosozumab was associated with a lower risk of vertebral fracture than placebo at 12 months and, after the transition to denosumab, at 24 months. The lower risk of clinical fracture that was seen with romosozumab was evident at 1 year. (Funded by Amgen and UCB Pharma; FRAME ClinicalTrials.gov number, NCT01575834.)

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“…For example, Harrington et al 16 reported that across several health systems in the U.S. only 14% of hip fracture patients were prescribed vitamin D. A challenge in the diagnosis and management of vitamin D deficiency in this population is the expense and lack of local availability of high-quality vitamin D assays, many of which do not accurately measure levels of 25 hydroxyergocalciferol (25(OH)D2), or vitamin D2 received from dietary sources and supplements.…”

Section: Introductionmentioning

confidence: 99%

Distribution and Correlates of Serum 25-Hydroxyvitamin D Levels in a Sample of Patients with Hip Fracture

Pieper

Colón‐Emeric

Caminis

et al. 2007

The American Journal of Geriatric Pharmacotherapy

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Sponsor's Role: Indicate sponsor's role in the design, methods, subject recruitment, data collections, analysis and preparation of paper.The study from which the data reported here were derived were part of a larger industry sponsored (Novartis) clinical trial testing the efficacy of a bisphosonate on hip-fracture. The design, analysis, interpretation and preparation of the results reported here were the responsibility and were determined by the lead author. NIH Public AccessAuthor Manuscript

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Hip fracture patients are not treated for osteoporosis: A call to action

Cited by 146 publications

References 24 publications

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Romosozumab Treatment in Postmenopausal Women with Osteoporosis

Distribution and Correlates of Serum 25-Hydroxyvitamin D Levels in a Sample of Patients with Hip Fracture

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