The Prevalence of Frailty in Patients Admitted to Hospital with Vertebral Fragility Fractures

Abstract

In the first study, frailty was identified in 70.8% of vertebral fracture patients using PRISMA-7 tool; 66.7% with the GFI; and 33.3% with the EFS. A further 20.8% were considered vulnerable to frailty on the EFS. Almost 30% were considered frail on all the three scales. Three quarters had a timed-up-and-go of >20seconds. Median Barthel Index was 18 (range 6-20); and the median abbreviated mental test was 9 (range 2-10), which suggests a cohort that is mostly independent with personal activities of daily living with good levels of cognition. In the second study, compared to patients with hip fracture, patients with vertebral fractures were younger; more likely to be living independently; less likely to have fallen in the last year; were taking more medication; and had equal number of co-morbidities as patients with hip fractures Conclusion: Frailty is prevalent in those admitted to hospital with a vertebral fragility fracture. Treatment of their acute fracture will need to include addressing their frailty issues.

Orthopaedic Surgeons Perceptions of Frailty and Frailty Screening

“…Managing frailty, fragility, and multi-morbidity in older patients who at a higher risk of poor outcomes such as falls, fracture, perioperative complications, readmission is an increasingly critical aspect of orthopaedic practice [23][24][25][26][27][28][29]. Yet, how frailty is understood and how the use of validated frailty screening tools could aid identification and augment integrated care in this context is markedly limited.…”

“…Orthopaedic surgeons routinely treat older patients presenting with common fragility fractures (e.g., hip, spine, wrist). These patients typically experience complex health problems, comorbidity, and/or higher degrees of dependence in activities of daily living [14]. In addition, individuals with higher levels of frailty in acute care settings are challenged to overcome the additional physiological challenges posed by trauma and subsequent surgery [15].…”

Fracture liaison services: improving outcomes for patients with osteoporosis

“…Most vertebral fractures are asymptomatic and only one-third present to medical attention 68. Symptomatic and asymptomatic vertebral fractures are associated with significant frailty, morbidity and mortality 69–72. In hospital, detection of vertebral fractures is poor and, even when detected, generally does not lead to initiation of any bone health assessment or treatment 73.…”

Orthopaedic surgeons’ perceptions of frailty and frailty screening

“…Orthopaedic surgeons routinely treat older patients presenting with fragility fractures (e.g., hip, spine, wrist). These patients typically experience complex health problems, comorbidity, and/or higher degrees of dependence in activities of daily living [14]. Individuals with higher levels of frailty in such acute care settings are challenged to overcome the additional physiological challenges posed by trauma and subsequent surgery [15].…”