Fracture Related IssuesScreening and Treatment of Osteoporosis After Hip Fracture: Comparison of Sex and Race
Introduction
With an aging population, osteoporosis (OP) and OP-related fractures are an important public health problem.
Hip fracture is the most serious consequence of OP with high morbidity and mortality associated with it (1). The 1-yr mortality rate after hip fracture has been estimated to be between 8.4% and 36% (2).
In addition to disability, the economic cost of hip fractures has become significant. An estimated $13 billion is spent each year in care for hip fractures in the United States. There is also the cost of post-fracture care. It has been recently found that 58% of the patients with hip fracture require long-term nursing facility care (3). A frequently recognized consequence of hip fracture is increased risk of recurrent fractures. The risk of future clinical fractures is about 10% (4), and the risk of recurrent hip fracture is about 15% in 4 yr (5).
The OP, the primary cause of low-impact hip fractures in the elderly, is rarely cited as an associated or secondary diagnosis in hospital admissions for such fractures (6). There is increasing body of evidence that antiresorptive therapy along with calcium and vitamin D reduces the risk of new hip fractures and recurrent hip fracture, as well as death from all causes (7). Also, the National Osteoporosis Foundation (NOF) recommends that all patients with fragility fractures of the hip should be treated for OP.
The aim of our study was to assess the rates of OP screening and treatment in Medicare for eligible patients after hip fracture. Similar studies in the past have documented poor rates of screening and treatment, however, with newer guidelines for treatment after hip fracture 8, 9, 10 as well as increased availability and lower cost of OP treatment; this study provides a more recent analysis of the current situation. The goal was to evaluate physician adherence to recommendations for both screening and treatment of OP after hip fracture in our hospital setting. We also wanted to determine if screening or treatment varied by patient race or gender. We hypothesized that screening and treatment rates of OP after hip fracture remain low overall and might vary by gender and race.
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Study Population
The study was done at an academic-based, county hospital in the Midwestern United States. The study protocol was approved by the Institutional Review Board of MetroHealth Medical Center. The hospital inpatient database was used to identify all patients aged 65 yr or older admitted to our institution between January 1, 2000 and December 31, 2010 and discharged with a primary ICD-9-CM diagnosis of hip fracture. If patients were readmitted within a 1-yr period, they were only included as a single
Results
Using the inpatient database, we identified a total of 596 patients who were discharged with a diagnosis of hip fracture between 2000 and 2010. Of the 596 patients, 417 met the study inclusion criteria and were included in the analysis (Fig. 1). The demographics for the study population are shown in Table 1. The median age of study subjects was 80 yr (range: 65–95), median age for women and men were 80.6 and 76.9 yr, respectively (p = 0.015). Of the population, 73% were female and 80% were white.
Discussion
Our study demonstrates that rates of OP screening and treatment after hip fracture remain low for both men and women in our hospital population. This finding is consistent with previous studies showing only 20% of patients with fractures received appropriate screening and adequate treatment for OP (12). Trends have shown improvement in screening of OP in the last decade; however, treatment elsewhere is still inadequate (13). In our population, 23.7% received any screening or treatment after
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2020, Journal of Clinical DensitometryCitation Excerpt :Osteoporosis in men may be overlooked except in severe cases (32). Women are more likely to be diagnosed/treated for osteoporosis after fractures (22,32), although the mortality rate posthip fracture is higher in men (12,16). Mortality posthip fracture reaches 12%–32% within the first year (1).
Differences in geometric strength at the contralateral hip between men with hip fracture and non-fractured comparators
2020, BoneCitation Excerpt :Nonetheless, it is worth noting that older men enrolled in BHS-7 would have benefited from pharmacological treatment with bisphosphonates. Given a study by Antonelli and colleagues suggests that only 8% of men initiate oral bisphosphates during hip fracture recovery, structural declines at the NN and IT regions may represent a critical gap in clinical care [24]. More broadly, our results illustrate the need for protocols in older adults who experience a hip fracture that utilize a more comprehensive strategy for prevention of secondary factures.
There was no grant support for this project.