Low rates of osteoporosis treatment after hospitalization for hip fracture in Hawaii

Nguyen, Edward T.; Posas-Mendoza, Therese; Siu, Andrea M; Ahn, Hyeong Jun; Choi, So Yung; Lim, Sian Yik

doi:10.1007/s00198-018-4553-2

Cited by 18 publications

(29 citation statements)

References 30 publications

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“…The results of our analysis are in line with other studies on secondary fracture prevention, which have demonstrated significant treatment gaps across healthcare systems and settings [ 19 – 26 , 28 , 30 ]. While many such studies are based in North America [ 19 – 22 , 25 , 26 , 28 ], our study along with several others demonstrate that the treatment gap seems to be a universal problem [ 23 , 24 , 30 ], also pertaining to European healthcare systems with a high level of access. Previous longitudinal studies have demonstrated an increasing treatment gap over time [ 25 , 26 ], and while our study provides more recent data with significant differences between the UK, Catalonia, and Denmark, the overall impression is that the gap is stable or increasing in recent years.…”

Section: Discussionsupporting

confidence: 89%

“…Despite such evidence-based recommendations, a significant post-fracture treatment gap is known to prevail across healthcare systems and settings [19][20][21][22][23][24][25][26][27][28]. Several publications report that in some countries as few as 10-20% of patients with fragility fractures go on to receive AOM [23][24][25][26][27], with this gap being more pronounced in men as well as in the elderly [20,26,29].…”

Section: Introductionmentioning

confidence: 99%

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Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

et al. 2020

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This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed. Introduction Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an antiosteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015. Methods This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture. Results A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women. Conclusion Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

et al. 2020

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“…Our study is limited to a single large health care system in Hawai‘i. Therefore our findings may not be generalizable to other health care systems [33]. Nevertheless, it does complement prior studies about suboptimal gout care, and as previously mentioned provides important information about gout care in Hawai‘i.…”

Section: Discussionmentioning

confidence: 45%

Patterns of health care utilization of gout patients in Hawai‘i-high rates of emergency department utilization as compared to rheumatoid arthritis

et al. 2019

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Recent and comprehensive research of gout in the Pacific region and Hawai‘i is significantly lacking. This study was conducted to improve the understanding of the healthcare utilization of gout patients within a single health care system in Hawai‘i. The objective was to examine gout inpatient, outpatient and emergency department care within a single health care system in Hawai‘i. This study was a retrospective chart review of patients, ≥ 18 years admitted to three Hawai‘i Pacific Health facilities for a primary diagnosis of gout or rheumatoid arthritis (RA) from 2011 to 2017. Population data for the State of Hawai‘i was used to calculate visit rates per 1,000 Hawai‘i adults. Trend analysis was performed to compare changes over time. We studied gout health care utilization concurrently with RA to provide an internal comparison group for the healthcare utilization patterns of interest. Gout patients were primarily managed in the outpatient setting with high rates of emergency department visits. In contrast, RA patients were primarily managed in the outpatient setting, with low rates of emergency department visits. Both gout and RA patients had low rates of inpatient admissions. The cost of gout emergency department visits was approximately 3.4 times higher than gout outpatient visits. The rates for gout emergency department visits, outpatient visits, inpatients visits, and RA outpatient visits in 2017 were trending downward and significantly changed from 2011 (p <0.05). The rates for RA emergency department visits and inpatient visits were not significantly changed from 2011–2017. Gout care in Hawai‘i remains suboptimal with higher rates of emergency department visits, as compared to RA. Because emergency department visits are associated with higher cost, efforts should be made to reduce these emergency department visits to improve the quality of care.

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“…The DEXA scanning rates in previous studies ranged from 1.4% in a retrospective cohort study by Barton et al [13] to 32.0% in Hawaii in a study by Nguyen et al [14] and to 52.9% in South Korea in a study by Park et al [15], which differ from the results of our study, as most of the physicians in our study agreed to performing DEXA bone mineral density (BMD) scan to middle-aged and elderly patients with suspected OVCF. The results of previous studies and our results suggest that the rate of BMD measurement has increased over the years; however, doctors' knowledge and attitude may not translate into action in diagnosis.…”

Section: Discussionmentioning

confidence: 94%

Management Trend and Attitude Regarding Osteoporotic Vertebral Compression Fracture: A Comparative Study Between Surgeons and Internists

Zhang

Fan

Liu

et al. 2020

Preprint

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Background: Osteoporotic vertebral compression fracture (OVCF) is the most common form of osteoporotic fracture, both surgeons and internists included in the management of that. This study aimed to identify whether a discrepancy exists between spinal surgeons and internists in the diagnosis and management of OVCF.Method: This comparative study included 124 spinal surgeons and 47 internists in the WeChat group of the Society of Osteoporosis and Bone Mineral Research. They were sent a self-administered electronic questionnaire that asked about practice pattern, diagnosis trend, and management choice in OVCF management. The validity of the survey was examined in advance.Results: A significantly higher percentage of surgeons obtained T2-weighted images scan with fat suppression than internists. A significantly higher proportion of spinal surgeons provided surgical treatment as first-line treatment and considered fracture as the most important aspect in OVCF management than internist. No significant difference was observed in the use of dual-energy X-ray absorptiometry scan, in performing laboratory examination, or in the collaboration rate between the two groups.Conclusion: Differences exist between internists and spinal surgeons in imaging diagnosis, choice of therapeutic schedule, and attitude to osteoporosis treatment in the management of OVCF.

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Low rates of osteoporosis treatment after hospitalization for hip fracture in Hawaii

Abstract: The use of osteoporosis medication for secondary prevention after admission for hip fracture in Hawaii is low. Efforts need to be made to improve treatment rates, especially among males.

Cited by 18 publications

References 30 publications

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

Patterns of health care utilization of gout patients in Hawai‘i-high rates of emergency department utilization as compared to rheumatoid arthritis

Management Trend and Attitude Regarding Osteoporotic Vertebral Compression Fracture: A Comparative Study Between Surgeons and Internists

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