Missed Opportunities for Osteoporosis Treatment in Patients Hospitalized for Hip Fracture

Abstract

OBJECTIVES: Although osteoporosis treatment can dramatically reduce fracture risk, rates of treatment after hip fracture remain low. In‐hospital initiation of recommended medications has improved outcomes in heart disease; hospitalization for hip fracture may represent a similar opportunity for improvement. The objective of this study was to examine rates of in‐hospital treatment with a combination of calcium and vitamin D (Cal+D) and antiresorptive or bone‐forming medications in patients hospitalized for hip fractures DESIGN: Observational cohort. SETTING: Three hundred eighteen hospitals in the United States. PARTICIPANTS: Fifty‐one thousand three hundred forty‐six patients aged 65 and older hospitalized for osteoporotic hip fracture. MEASUREMENTS: In‐hospital administration of Cal+D and antiresorptive or bone‐forming medications. RESULTS: Three thousand four hundred five patients (6.6%) received Cal+D anytime after a procedure to correct femoral fracture; 3,763 patients (7.3%) received antiresorptive or bone‐forming medications. Only 1,023 patients (2.0%) were prescribed ideal therapy, receiving Cal+D and an antiresorptive or bone‐forming medication. Treatment rates remained low across virtually all patient‐, provider‐, and hospital‐level characteristics. The strongest predictor of treatment with Cal+D was the receipt of an antiresorptive or bone‐forming medication (adjusted odds ratio=5.50, 95% confidence interval=4.84–6.25), but only 27.2% of patients who received these medications also received Cal+D. CONCLUSION: Rates of in‐hospital initiation of osteoporosis treatment for patients with hip fracture are low and may represent an opportunity to improve care.

Gender Differences in Osteoporosis and Fractures

“…In a recent large study (n = 51,346) of adults admitted to hospitals in North Carolina with a hip fracture, osteoporosis treatment was broadly defined as receipt of calcium plus vitamin D and antiresorptive or bone-forming medications [17]. Men were about 75% less likely to receive osteoporosis treatment during the hospital stay than women; only 2.2% of men received any osteoporosis treatment, compared to 8.9% of women.…”

Osteoporosis and its complications: treatment adherence and possibilities of its enhancement

“…Так, по данным разных исследова-телей, она варьирует в широких пределах, но не превышает 40% в случаях, когда не зафиксировано дополнительное вмешательство исследователей в работу врачей системы об-щественного здравоохранения [3][4][5][6].…”

“…В исследованиях зарубежных авторов [3][4][5][6] неодно-кратно отмечалось редкое назначение противоостеопоро-тической терапии врачами первичного звена. В нашем ис-следовании анкетирование лиц с МОП также продемон-стрировало, что ни одна из опрошенных пациенток не по-лучила рекомендации по данному виду терапии при выпи-ске из стационара, где она находилась сразу после перело-ма.…”

CORR Insights®: A Resident-led Initiative Improves Screening and Treatment for Vitamin D Deficiency in Patients with Hip Fractures

“…A variety of protocols have been described for assessing bone health after a fracture, including assessment by the orthopaedic surgeon during the initial hospitalization, consultation of endocrinologists during the initial hospitalization, alerting the patient's primary care provider of the occurrence of a fracture, or followup with a fracture liaison service. All of these have been described as having variable levels of success in improving rates of bone health evaluation [1,3]. The most-critical initial step is the initial identification of a given fracture as being a harbinger of poor bone health.…”