Secondary Prevention Of Hip Fractures Among Hospitalized Elderly: Are We Doing Enough?

摘要

Background: Older individuals with hip fractures almost always have osteoporosis. Such individuals are at increased risk of suffering other osteoporotic fractures including recurrent hip fractures. The management of such patients should include assessing bone mineral density and treating osteoporosis. Objective: To investigate if elderly (> 65 years) patients with hip fractures were assessed and treated for osteoporosis. Methods: A retrospective chart review of all elderly patients who underwent hip fracture surgery at a university teaching hospital during the calendar years 1997 to 1999. Results: A total of 95 subjects were identified (29% males and 71% females). Subjects' age ranged from 65 to 96 years with a mean (+SD) 81+7 years. Femoral neck fractures were the most common (51%), followed by intertrochanteric (43%), and subtrochanteric fractures (3%). Two subjects (2%) had fractures at multiple sites. The most common cause of a hip fracture was a fall (87%). Other causes included road traffic accidents (6%), as well as other trauma (4%). One subject had a spontaneous hip fracture. A history of previous hip fractures was obtained in 8% of subjects. Osteoporosis was diagnosed in 17% of subjects prior to admission. On admission, 9% of subjects were receiving calcium, 3% were receiving vitamin D, none were receiving alendronate, and one subject was receiving calcitonin. About 3% of female subjects were receiving estrogen on admission. On discharge, 11% of subjects were prescribed calcium, 6% were prescribed vitamin D, none were prescribed alendronate, and 2% were on calcitonin. None of the female subjects were discharged on estrogen. During hospitalization, 88% of subjects who were admitted to non-medical services were seen by either a geriatric of a general internal medicine consult. Obtaining a medical and/or geriatric consult did not have apparent effect on the frequency of treating osteoporosis in this high risk group of subjects. Conclusion: Older adults with hip fractures are not adequately treated for osteoporosis. This places them at increased risk of other osteoporotic fractures including recurrent hip fractures. Introduction In the U.S., about half a million 50,000 hip fractures occur each year.1 Hip fractures are an important cause of mortality and morbidity among older adults. About 20% of patients with hip fractures die within a year, with most of the deaths occurring within the first 6 months after a fracture.2 Among survivors, 30 to 50% never regain their pre-fracture functional status.3 Miller4 reported that 15 to 20% of individuals who had a hip fracture remained in a nursing home for at least a year, and 50% were never able to walk again. Of those who returned home, 25 to 35% had to rely on other persons and/or assistive devices for mobility. A 6-year follow-up study of 185 patients who had experienced a hip fracture showed that only 9% were able to walk on their own.5 Healthcare expenditure attributable to hip fractures is substantial. In the U.S., hip fractures consumed $8.8 billion of the total health budget in 1995.6 Individuals who had a hip fracture are at increased risk of suffering other osteoporotic fractures including recurrent hip fractures. In a study from Sweden, 39 men with hip fractures subsequently had 56% more osteoporotic fractures (including hip fractures) compared to a control group.7 In a large population-based study in Rochester, Minnesota in the U.S., men with hip fractures had a 3.2-fold increase in the risk of a second hip fracture compared to those without previous fractures.8 Of participants of the Baltimore Longitudinal Study on Aging with a first hip fracture, 7.3% had a second hip fracture during a 7-year follow-up period.9 The management of patients with hip fracture should include assessing bone mineral density and treating osteoporoiss.10 In a prior study conducted in a community teaching hospital,11 we reported that elderly hospitalized patients with hip fractures were not ad