A systematic review of the outcomes of&amp;nbsp;osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and&amp;nbsp;mortality

Nazrun, A. S.; Khaithir, Tzar Mohd Nizam; Mokhtar, Sabarul Afian; Mohamed, Isa Naina

doi:10.2147/tcrm.s72456

Cited by 102 publications

(49 citation statements)

References 59 publications

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“…They also concluded that surgical delays increased the risk of complications. Another review examined the outcomes of patients with osteoporotic fractures after hospital discharge [ 12 ]. Those patients were reported to be at high risk of morbidity, mortality, and subsequent fracture.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis

Mathew

Gane

Heesch

et al. 2016

BMC Med

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BackgroundOlder adults hospitalized with fragility fractures are at high risk of negative events that can culminate in re-presentations to hospital emergency departments or readmissions to hospital. This systematic review aimed to identify patient, clinical, or hospital-related factors that are identifiable at the index admission and that may be associated with re-presentations to hospital emergency departments or hospital readmissions in older adults following fragility fractures.MethodsFour electronic databases (PubMed, CINAHL, Embase, and Scopus) were searched. A suite of search terms identified peer-reviewed English-language articles that examined potential correlates of hospital re-presentation in older adults (mean age ≥ 65 years) who were discharged from hospital following treatment for fragility fractures. A three-stage screening process (titles, abstracts, full text) was conducted by two researchers independently. Participant characteristics, study design, potential correlates examined, analyses, and findings were extracted for studies included in the review. Quality and risk of bias were assessed with the Effective Public Health Practice Project Quality Assessment Tool. The strength of evidence was incorporated into a best evidence synthesis, and meta-analysis was conducted where effect pooling was possible.ResultsEleven of 35 eligible studies were categorized as high quality studies. These studies reported that age, higher Cumulative Illness Rating scores, American Society of Anesthesiologists scores > 3, longer length of stay, male sex, cardiovascular disease, low post-operative hemoglobin, kidney disease, dementia and cancer were factors identified at the index admission that were predictive of subsequent re-presentation to hospital. Age was the only predictor for which pooling of effects across studies was possible: pooling was conducted for re-presentation ≤ 30 days (pooled OR, 1.27; 95 % CI, 1.14–1.43) and > 30 days (pooled OR, 1.23; 95 % CI, 1.01–1.50).ConclusionsThe best-evidence synthesis, in addition to the meta-analysis, identified a range of factors that may have utility in guiding clinical practice and policy guidelines for targeted interventions to reduce the need for re-presentation to hospital among this frail clinical population. The paucity of studies investigating re-presentations to hospital emergency departments without admission was an important gap in the literature identified in this review. Key limitations were exclusion of non-English language studies and grey literature.Systematic review registrationPROSPERO CRD42015019379.

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Section: Introductionmentioning

confidence: 99%

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis

Mathew

Gane

Heesch

et al. 2016

BMC Med

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“…In addition to this, in the year following a hip fracture, there is a twofold increase in mortality,12 estimated to be ~30%, and it is higher among male patients (37.5%) 13. Vertebral osteoporotic fractures are often asymptomatic, therefore escaping clinical diagnosis; however, when compared to other types of fragility fractures, they are associated with higher comorbidity, higher incidence of hospitalization, and longer hospital stays 14. In addition, they have been strongly related to subsequent fractures and mortality 14,15.…”

Section: Introductionmentioning

confidence: 99%

“…Vertebral osteoporotic fractures are often asymptomatic, therefore escaping clinical diagnosis; however, when compared to other types of fragility fractures, they are associated with higher comorbidity, higher incidence of hospitalization, and longer hospital stays 14. In addition, they have been strongly related to subsequent fractures and mortality 14,15. The residual lifetime risk of vertebral osteoporotic fractures is 8.6% for men aged ≥45 years and 15.4% for women 14.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, they have been strongly related to subsequent fractures and mortality 14,15. The residual lifetime risk of vertebral osteoporotic fractures is 8.6% for men aged ≥45 years and 15.4% for women 14. Distal radius fractures (occurring at the wrist) are more prevalent in women aged 45–65 years, and the most common mechanism of these fractures is direct trauma 16.…”

Section: Introductionmentioning

confidence: 99%

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Effects of water-based exercise on bone health of middle-aged and older adults: a systematic review and meta-analysis

Simas¹,

Hing²,

Pope³

et al. 2017

OAJSM

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BackgroundAge-related bone loss is a major health concern. Only exercises associated with high-impact and mechanical loading have been linked to a positive effect on bone turnover; however, these types of exercises may not always be appropriate for middle-aged and older adults due to physical decline or chronic disorders such as osteoarthritis. Water-based exercise (WBE) has been shown to affect different components of physical fitness, has lower risks of traumatic fracture, and applies less stress to joints. However, the effects of WBE on bone health are unclear.ObjectiveThis study aimed to explore whether WBE is effective in preventing age-related bone deterioration in middle-aged and older adults.MethodsA search of relevant databases and the references of identified studies was performed. Critical narrative synthesis and meta-analyses were conducted.ResultsEleven studies, involving 629 participants, met all inclusion criteria. All participants were postmenopausal women. Eight studies compared WBE to a sedentary control group, and four studies had land-based exercise (LBE) participants as a comparison group. Meta-analyses revealed significant differences between WBE and control group in favor of WBE for changes in bone mineral density (BMD) at the lumbar spine (mean difference [MD] 0.03 g/cm2; 95% confidence interval [CI]: 0.01 to 0.05) and femoral neck (MD 0.04 g/cm2; 95% CI: 0.02 to 0.07). Significant differences were also revealed between WBE and LBE in favor of LBE for changes in lumbar spine BMD (MD −0.04 g/cm2; 95% CI: −0.06 to −0.02). However, there was no significant difference between WBE and LBE for changes in femoral neck BMD (MD −0.03 g/cm2; 95% CI: −0.08 to 0.01).ConclusionWBE may have benefits with respect to maintaining or improving bone health in postmenopausal women but less benefit when compared to LBE. Further research is required on this topic.

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“…These rates typically include re-presentations due to conditions present or associated with the initial hospitalisation, fracture non-union, mal-union, re-fracture at the same site or new fractures elsewhere [ 3 , 19 , 20 ]. Appropriate clinical care during and following the initial hospitalisation may reduce subsequent hospital re-presentations [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for hospital re-presentation among older adults following fragility fractures: protocol for a systematic review

et al. 2015

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BackgroundAfter being discharged from hospital following the acute management of a fragility fracture, older adults may re-present to hospital emergency departments in the post-discharge period. Early re-presentation to hospital, which includes hospital readmissions, and emergency department presentations without admission may be considered undesirable for individuals, hospital institutions and society. The identification of modifiable risk factors for hospital re-representation following initial fracture management may prove useful for informing policy or practice initiatives that seek to minimise the need for older adults to re-present to hospital early after they have been discharged from their initial inpatient care. The purpose of this systematic review is to identify correlates of hospital re-presentation in older patients who have been discharged from hospital following clinical management of fragility fractures.Methods/DesignThe review will follow the PRISMA-P reporting guidelines for systematic reviews. Four electronic databases (PubMed, CINAHL, Embase, and Scopus) will be searched. A suite of search terms will identify peer-reviewed articles that have examined the correlates of hospital re-presentation in older adults (mean age of 65 years or older) who have been discharged from hospital following treatment for fragility fractures. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the quality of the studies. The strength of evidence will be assessed through best evidence synthesis. Clinical and methodological heterogeneity across studies is likely to impede meta-analyses.DiscussionThe best evidence synthesis will outline correlates of hospital re-presentations in this clinical group. This synthesis will take into account potential risks of bias for each study, while permitting inclusion of findings from a range of quantitative study designs. It is anticipated that findings from the review will be useful in identifying potentially modifiable risk factors that have relevance in policy, practice and research priorities to improve the management of patients with fragility fractures.Systematic review registrationPROSPERO CRD42015019379

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A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality

Cited by 102 publications

References 59 publications

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis

Effects of water-based exercise on bone health of middle-aged and older adults: a systematic review and meta-analysis

Risk factors for hospital re-presentation among older adults following fragility fractures: protocol for a systematic review

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