The Journal of Bone and Joint Surgery (American) 84:1342-1348 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Improvement in the Undertreatment of Osteoporosis Following Hip Fracture
Michael J. Gardner, MD,
Kyle R. Flik, MD,
Pekka Mooar, MD and
Joseph M. Lane, MD
Investigation performed at New York Presbyterian Hospital-Weill
Cornell Medical Center, New York, New York; New York Hospital Queens,
Flushing, New York; and Medical College of Pennsylvania and Hahnemann
University School of Medicine, Philadelphia, Pennsylvania
Michael J. Gardner, MD
Kyle R. Flik, MD
Joseph M. Lane, MD
Department of Orthopaedic Surgery, The Hospital for Special Surgery,
535 East 70th Street, New York, NY 10021. E-mail address for M.J.
Gardner: gardnerm{at}hss.edu E-mail address for K.R. Flik: flikk@hss.edu.
E-mail address for J.M. Lane: lanej@hss.edu
Pekka A. Mooar, MD
Department of Orthopaedic Surgery, Medical College of Pennsylvania
and Hahnemann University School of Medicine, 3300 Henry Avenue,
Philadelphia, PA 19129. E-mail address: pekka.mooar@drexel.edu
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. They did not
receive payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other
charitable or nonprofit organization with which the authors are
affiliated or associated.
A commentary is available with the electronic versions of this article,
on our web site (www.jbjs.org) and on our quarterly CD-ROM (call
our subscription department, at 781-449-9780, to order the CD-ROM).
Background:
Osteoporosis is a common disease characterized by decreased bone
mass and increased fracture risk in postmenopausal women and the
elderly. Hip fractures are among the most common consequences of
osteoporosis and unfortunately usually occur late in the course
of the disease. When a patient is admitted to the hospital with
a fragility hip fracture, a unique opportunity for diagnosis and
treatment presents itself. Fortunately, several medications have
proven to be effective in lowering the risk of future fractures.
The purposes of the present study were to test the hypothesis that
most fragility hip fractures go untreated and to determine whether educational
efforts to raise physician awareness have led to an improvement
in osteoporosis treatment rates.
Methods:
A retrospective cohort study was performed with use of the patient
databases at two university medical centers and one university-affiliated
community hospital. The charts of 300 randomly selected patients
were sorted with use of ICD-9 (International Classification of Diseases,
Ninth Revision) codes for femoral neck fractures. There were 100
patients from each center, with twenty-five patients from each year between
1997 and 2000. The admitting diagnosis, mechanism of injury, admission
medications, procedures performed during hospitalization, and discharge
medications were then extracted and analyzed. During this period,
the National Osteoporosis Foundation established guiding principles
for the treatment of fragility fractures.
Results:
Of the seventy-five patients from all centers for each year from
1997 to 2000, 11%, 13%, 24%, and 29%, respectively, were discharged
with a prescription for some medication targeting osteopenia, either
supplemental calcium or an antiosteoporotic medication (estrogen,
calcitonin, a bisphosphonate, or raloxifene). A trended chi-square
analysis of this increase revealed a p value of <0.001, indicating
that this improvement in treatment was unlikely due to chance alone.
Fifty-eight (19.3%) of the 300 patients in the study received a
prescription at the time of discharge. However, forty of these patients (13.3%
of the overall group) received calcium and only eighteen (6.0% of
the overall group) received a medication to actively prevent bone
resorption and treat osteoporosis. In addition, no patient underwent
a bone density scan while in the hospital.
Conclusions:
Elderly patients and postmenopausal women who are admitted to the
hospital and diagnosed with a low-energy femoral neck fracture have
been undertreated for osteoporosis. However, over the four years
of the present study, there was a significant increase in the rate
of treatment. It is hoped that treatment rates will continue to
increase in the future with continued educational efforts.
 CiteULike  Connotea  Del.icio.us  Facebook  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
H. S. Gong, W. S. Oh, M. S. Chung, J. H. Oh, Y. H. Lee, and G. H. Baek
Patients with Wrist Fractures Are Less Likely to Be Evaluated and Managed for Osteoporosis
J. Bone Joint Surg. Am.,
October 1, 2009;
91(10):
2376 - 2380.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Miki, M. E. Oetgen, J. Kirk, K. L. Insogna, and D. M. Lindskog
Orthopaedic Management Improves the Rate of Early Osteoporosis Treatment After Hip Fracture. A Randomized Clinical Trial
J. Bone Joint Surg. Am.,
November 1, 2008;
90(11):
2346 - 2353.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Rabenda, J. Vanoverloop, V. Fabri, R. Mertens, F. Sumkay, C. Vannecke, A. Deswaef, G. A. Verpooten, and J.-Y. Reginster
Low Incidence of Anti-Osteoporosis Treatment After Hip Fracture
J. Bone Joint Surg. Am.,
October 1, 2008;
90(10):
2142 - 2148.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. L. Tosi, R. Gliklich, K. Kannan, and K. J. Koval
The American Orthopaedic Association's "Own the Bone" Initiative to Prevent Secondary Fractures
J. Bone Joint Surg. Am.,
January 1, 2008;
90(1):
163 - 173.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G. Skedros, C. L. Sybrowsky, and G. J. Stoddard
The Osteoporosis Self-Assessment Screening Tool: A Useful Tool for the Orthopaedic Surgeon
J. Bone Joint Surg. Am.,
April 1, 2007;
89(4):
765 - 772.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Schulman, S. Williams, O. Khera, T. Sahba, J. Michelson, and K. Fine
Effective Osteoporosis Education in the Outpatient Orthopaedic Setting
J. Bone Joint Surg. Am.,
February 1, 2007;
89(2):
301 - 306.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. A. Streeten, A. Mohamed, A. Gandhi, D. Orwig, P. Sack, R. Sterling, and V. D. Pellegrini Jr.
The Inpatient Consultation Approach to Osteoporosis Treatment in Patients with a Fracture. Is Automatic Consultation Needed?
J. Bone Joint Surg. Am.,
September 1, 2006;
88(9):
1968 - 1974.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. T Gold, I. M Alexander, and M. P Ettinger
How Can Osteoporosis Patients Benefit More from Their Therapy? Adherence Issues with Bisphosphonate Therapy
Ann. Pharmacother.,
June 1, 2006;
40(6):
1143 - 1150.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G. Skedros, J. D. Holyoak, and T. C. Pitts
Knowledge and Opinions of Orthopaedic Surgeons Concerning Medical Evaluation and Treatment of Patients with Osteoporotic Fracture
J. Bone Joint Surg. Am.,
January 1, 2006;
88(1):
18 - 24.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Heetveld, E. L. F. B. Raaymakers, B. L. van Eck-Smit, A. D. P. van Walsum, and J. S. K. Luitse
Internal fixation for displaced fractures of the femoral neck: DOES BONE DENSITY AFFECT CLINICAL OUTCOME?
J Bone Joint Surg Br,
March 1, 2005;
87-B(3):
367 - 373.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Gardner, R. H. Brophy, D. Demetrakopoulos, J. Koob, R. Hong, A. Rana, J. T. Lin, and J. M. Lane
Interventions to Improve Osteoporosis Treatment Following Hip Fracture. A Prospective, Randomized Trial
J. Bone Joint Surg. Am.,
January 1, 2005;
87(1):
3 - 7.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Cole
What's New in Orthopaedic Trauma
J. Bone Joint Surg. Am.,
November 1, 2003;
85(11):
2260 - 2269.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Kaufman, M. E. Bolander, A. D. Bunta, B. J. Edwards, L. A. Fitzpatrick, and C. Simonelli
Barriers and Solutions to Osteoporosis Care in Patients with a Hip Fracture
J. Bone Joint Surg. Am.,
September 1, 2003;
85(9):
1837 - 1843.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. J. Koval, R. Meek, E. Schemitsch, F. Liporace, E. Strauss, and J. D. Zuckerman
An AOA Critical Issue. Geriatric Trauma: Young Ideas
J. Bone Joint Surg. Am.,
July 3, 2003;
85(7):
1380 - 1388.
[Full Text]
[PDF]
|
|
|
|
