Osteoporotic hip fractures have become an increasingly common healthcare burden with significant morbidity and mortality in the geriatric population. Pharmacological management of the underlying osteoporosis is critical. Our objective is to determine the percentage of patients older than 65 who receive pharmacologic treatment of osteoporosis within six months after a fragility fracture at Cabell Huntington Hospital.
Data was extracted from medical records for patients age 65 or older who sustained a hip fracture during June 2013 - March 2015. Patients who received any form of pharmacologic treatment within six months after their fractures were identified. All analyses were performed using SAS version 9.3 (SAS Institute, Cary, North Carolina).
Among the 193 patients who met the inclusion criteria, 26% (n=50) received pharmacologic treatment within six months after fracturing versus 74% (n=143) who did not receive any type of pharmacologic therapy after the fracture. Female was the predominant gender in pharmacologic treatment group (74% vs 71%). Mean age was 81 years old in both groups (81±9 vs 82±8), mean BMI was 25 in both groups (25±5 vs 25±6). There was no significant difference in pharmacologic management when the patients were stratified according to age group.
Patients were pharmacologically undertreated after an osteoporotic hip fracture, regardless of the age of fracture presentation. Due to potential benefits of pharmacologic treatment after osteoporotic hip fracture, treatment should be initiated prior to discharge, if possible. If this is not feasible for the patient, specific and detailed instructions should be given to the patient’s primary care physician, or endocrinologist if medically complicated, for initiating therapy and proper management of the patient.
Conflict(s) of Interest
References with DOI
1. Shuler FD, Conjeski J. Defining bone health and fracture risk in West Virginia: the World Health Organization FRAX assessment tool. The West Virginia Medical Journal. 2011;107(5):12-7.
2. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2014;25(10):2359-81. https://doi.org/10.1007/s00198-014-2794-2
3. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. American Journal of Public Health. 1990;80(7):871-3. https://doi.org/10.1016/0022-4375(91)90022-n
4. Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporosis International : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2004;15(2):87-94. https://doi.org/10.1007/s00198-003-1515-z
5. Schroder HM, Petersen KK, Erlandsen M. Occurrence and incidence of the second hip fracture. Clinical Orthopaedics and Related Research. 1993(289):166-9. https://doi.org/10.1097/00003086-199304000-00022
6. Ensrud KE, Barrett-Connor EL, Schwartz A, Santora AC, Bauer DC, Suryawanshi S, et al. Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the Fracture Intervention Trial long-term extension. Journal of Bone and Mineral Research : the official journal of the American Society for Bone and Mineral Research. 2004;19(8):1259-69. https://doi.org/10.1359/jbmr.040326
7. Chesnut CH, 3rd, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. Journal of Bone and Mineral Research : the official journal of the American Society for Bone and Mineral Research. 2004;19(8):1241-9. https://doi.org/10.1359/jbmr.040325
8. Chesnut CH, 3rd, Silverman S, Andriano K, Genant H, Gimona A, Harris S, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. The American Journal of Medicine. 2000;109(4):267-76. https://doi.org/10.1016/s0002-9343(00)00490-3
9. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. Jama. 1999;282(7):637-45. https://doi.org/10.1001/jama.282.7.637
10. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. The New England Journal of Medicine. 2009;361(8):756-65. https://doi.org/10.1097/01.ogx.0000363236.41902.96
11. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. The New England Journal of Medicine. 2001;344(19):1434-41. https://doi.org/10.3171/foc.2001.11.2.8
12. Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. The New England Journal of Medicine. 2007;357(18):1799-809. https://doi.org/10.1056/nejmoa074941
13. Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ quality & safety. 2016;25(12):986-92. https://doi.org/10.7812/tpp/15-141
14. Kanis JA. Osteoporosis and osteopenia. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1990;5(3):209-11. 8 Marshall Journal of Medicine, Vol. 3 , Iss. 3, Art. 12 http://mds.marshall.edu/mjm/vol3/iss3/12 DOI: http://dx.doi.org/10.18590/mjm.2017.vol3.iss3.12; https://doi.org/10.1002/jbmr.5650050302
15. Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. The American Journal of Medicine. 2000;109(4):326-8. https://doi.org/10.1016/s0002-9343(00)00457-5
16. Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Archives of internal medicine. 2002;162(19):2217-22. https://doi.org/10.1001/archinte.163.10.1236-b
17. LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. Jama. 1999;281(16):1505-11. https://doi.org/10.1001/jama.281.16.1505
18. Diamond T, Smerdely P, Kormas N, Sekel R, Vu T, Day P. Hip fracture in elderly men: the importance of subclinical vitamin D deficiency and hypogonadism. The Medical journal of Australia. 1998;169(3):138-41.
19. Recker RR, Hinders S, Davies KM, Heaney RP, Stegman MR, Lappe JM, et al. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. Journal of Bone and Mineral Research : the official journal of the American Society for Bone and Mineral Research. 1996;11(12):1961-6. https://doi.org/10.1002/jbmr.5650111218
20. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. The New England Journal of Medicine. 1992;327(23):1637-42. https://doi.org/10.1097/00006254-199305000-00026
21. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. The New England Journal of Medicine. 1997;337(10):670-676. https://doi.org/10.1056/nejm199709043371003
22. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Bmj. 1996;312(7041):1254-9. https://doi.org/10.1136/bmj.312.7041.1254
23. Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. Jama. 2002;288(15):1889-97. https://doi.org/10.1001/jama.288.15.1889
24. Unnanuntana A, Gladnick BP, Donnelly E, Lane JM. The assessment of fracture risk. The Journal of Bone and Joint Surgery American volume. 2010;92(3):743-53. https://doi.org/10.2106/jbjs.i.00919
25. Dawson-Hughes B, Tosteson AN, Melton LJ, 3rd, Baim S, Favus MJ, Khosla S, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2008;19(4):449-58. https://doi.org/10.1007/s00198-008-0559-5
Klaus, Joseph; Modarresi, Milad; Aguilar, Rodrigo; BenHamed, Nasreen; and Shuler, Franklin D.
"Improving the Pharmacologic Management of Patients after Osteoporotic Hip Fractures,"
Marshall Journal of Medicine:
3, Article 12.
Available at: https://mds.marshall.edu/mjm/vol3/iss3/12