Osteoporotic fractures in older adults

Abstract

Osteoporotic fractures are emerging as a major public health problem in the aging population. Fractures result in increased morbidity, mortality and health expenditures. This article reviews current evidence for the management of common issues following osteoporotic fractures in older adults including: (1) thromboembolism prevention; (2) delirium prevention; (3) pain management; (4) rehabilitation; (5) assessing the cause of fracture; and (6) prevention of subsequent fractures. Areas for practice improvement and further research are highlighted. Keywords osteoporosis; fractures; agedAs the population ages, osteoporosis is emerging as a major public health problem. At 50 years of age, 4 in 10 women will experience a hip, vertebral or forearm fracture in their remaining lifetime, and are more likely to die from complications of fracture than from breast cancer. 1 Although osteoporosis is frequently considered to be a disease of elderly women, men account for 30% of hip fractures worldwide 2,3 , and mortality after such fractures is greater in men than in women. 4Osteoporotic fractures result in substantial healthcare resource utilization; more than 400 000 hospitalizations, 3.4 million outpatient visits and 179 000 nursing home stays were reported in the USA in 1995. The direct medical costs of treating osteoporotic fractures total $13.8 billion. 5 Furthermore, patients who survive an osteoporotic fracture use more than twice the healthcare resources compared with similar patients without fractures for at least 3 years after their event. 6 More difficult to calculate is the human cost associated with osteoporotic fractures. Increased mortality, pain, disability, depression and loss of independence have been well documented after hip and vertebral fractures. 7-11Due to the high risk of morbidity and mortality after an osteoporotic fracture, older adults require an interdisciplinary approach to their care. In particular, attention must be given to the prevention of common fracture complications, rehabilitation, assessment of the cause of fracture, and prevention of subsequent fractures. This paper will review current evidence and recommendations in each of these areas. PREVENTION OF COMMON FRACTURE COMPLICATIONSWhen caring for an older adult presenting with an acute fracture, the most immediate complications that must be addressed are thromboembolism, delirium and pain management. Fortunately, effective preventive measures are available for each of these problems. ThromboembolismDeep vein thromboembolism (DVT) occurs in over 40% of hip fracture patients without prophylaxis. 12 A single study reported that patients with pelvic and lower extremity fractures have a similarly high risk of DVT 13 , although in a younger trauma population. The incidence of DVT in other types of fractures is unknown.A meta-analysis of randomized controlled trials showed that unfractionated or low-molecularweight heparin (LMWH) reduces the absolute incidence of DVT by 16%, suggesting that about six hip fracture patients need to be ...

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

“…Given that spine fractures are often asymptomatic and underreported [34], the observed increase may reflect improvements in reporting and diagnosing these fractures. Using dual X-ray absorptiometry (DXA)-based vertebral fracture assessment, Rodondi et al [35] estimated one third of LTC residents had a prevalent vertebral fracture, although they commonly go undetected in elderly residents and may be a substantial source of pain and agitation [36]. The increase we observed in pelvic fractures was also found in a Dutch study between 1986 and 2011 [37] and may reflect better detection with increased use of computed tomography (CT) and magnetic resonance imaging (MRI) examinations [28].…”

Vertebroplasty with self-locking hexagonal metal implants shows comparable primary and secondary stiffness to PMMA cement augmentation techniques in a biomechanical vertebral compression fracture model

“…The increasing average age of the population in western countries elevates the incidence and co-morbidities of reduced low bone marrow density [5,19,28,40]. Osteoporosis as the most common cause for low BMD values and VCF as one of its signs of mechanical insufficiency is still a problem in the surgical treatment of the elderly and has a major impact on the socio-economical costs.…”

“…Therefore, adequate surgical strategies are getting in focus because of the burden of the disease comprising pain, impaired mobility and reduced quality of life [5,19,28,37]. Different implants and techniques for fixation and/or stabilisation of the fractured vertebral body are being investigated with clinical and ex vivo studies [6,10,17,23,27,33].…”

The Association of Adherence to Osteoporosis Therapies with Fracture, All-Cause Medical Costs, and All-Cause Hospitalizations: A Retrospective Claims Analysis of Female Health Plan Enrollees with Osteoporosis

“…Osteoporotic fractures may also be associated with depression, functional impairment, cognitive impairment, pain, disability, and decline in lung function. [15][16][17] Patients whose fractures are treated in inpatient facilities may require subsequent hospitalization for post-operative complications, such as chest infection, cardiac failure, deep vein thrombosis, 18 or pneumonia. Moreover, there are costs associated with osteoporosis that are not specific to fracture, such as physician visits and bone density scans.…”