Diagnosis and Treatment of Osteoporosis in High-Risk Patients Prior to Hip Fracture

Abstract

Purpose: Hip fractures in older adults are common and serious events. Patients who sustain fragility hip fractures are defined as having osteoporosis. Patients with dementia or a history of a prior fragility fracture are at increased risk of a future fracture. This study assesses prefracture osteoporosis diagnosis and treatment in high-risk groups. Methods: A case-control analysis of a database of all patients age !60 years admitted for surgical repair of nonpathological, low-impact femur fracture between May 2005 and October 2010 was performed. Results: Of 1070 patients, 511 (47.8%) had dementia and 435 (40.7%) had been diagnosed with osteoporosis prior to admission. Patients with dementia were more likely to have a diagnosis of osteoporosis prior to their fracture than those without dementia (43.8% vs 37.7%, P < .05). Twenty-five percent of the total study population had been treated with calcium and vitamin D (CalþD) prior to admission, and 12% with other osteoporosis medications. There was a trend toward patients with dementia being more likely to have been on CalþD prior to admission (27.6% vs 22.5%, P ¼ .06), but no difference in treatment with other agents (10.8% vs 13.1%, P ¼ .25). Patients with prior fragility fractures were more likely to be on CalþD (32.3% vs 25.0%, P < .02); however, there was no difference in the use of other osteoporosis medications (12.3% vs 12%, P ¼ .90). Conclusion: Fewer than half of patients that presented with hip fractures were diagnosed with osteoporosis prior to fracture and primary preventative treatment rates were low. Although patients with dementia are more likely to be diagnosed with osteoporosis, they were not more likely to be treated, despite having a greater risk. Additionally, those with prior fragility fractures are often not on preventative treatment. This may represent a missed opportunity for prevention and room for improvement in order to reduce osteoporotic hip fractures.

Association of gastrointestinal events and osteoporosis treatment initiation in newly diagnosed osteoporotic Israeli women

“…The initiation rate in this study was higher when compared with studies examining the prefracture osteoporosis treatment rate among those patients presenting with a fracture. These rates ranged from 8% to 17% . Even after fractures, patients reported in the literature tend to have low osteoporosis treatment initiation rates, ranging primarily from 8% to 24% .…”

High rate of non-treatment among osteoporotic women enrolled in a US Medicare plan

“…Previous studies have demonstrated that non-treatment of osteoporosis is common [8][9][10][11][12][13][14][15][16][17][18][19][20] , whether assessed after clinical or self-reported OP diagnosis 10,20 , before OP-related fractures 8,11,16 , or after fractures 9,[11][12][13][14][15][16][17][18][19] . Common barriers to treatment initiation include: concerns over side effects 21 including gastro-intestinal (GI) events [22][23][24][25] , cost 26 , and patient frailty 26 .…”

“…Common barriers to treatment initiation include: concerns over side effects 21 including gastro-intestinal (GI) events [22][23][24][25] , cost 26 , and patient frailty 26 . While some previous studies have attempted to identify characteristics associated with the likelihood of OP treatment [8][9][10]19 , most published studies have focused on treatment among patients newly indicated for treatment and did not include patients with prior use of therapy, even though prior osteoporosis therapy has been shown to be predictive of future treatment 27 . Additionally, few studies of OP nontreatment focus on a Medicare population.…”

Influencia de un programa de revitalización geriátrica como actividad física sobre la densidad mineral ósea y el riesgo de caídas en personas con enfermedad de Alzheimer

“…Algunos estudios han demostrado la asociación entre la pérdida de densidad mineral ósea y el deterioro cognitivo (514)(515)(516) , así como con la EA (517)(518)(519)(520)(521) . Los enfermos de…”

“…Son muchos los autores que enfocan sus investigaciones hacia la comorbilidad entre la EA (517)(518)(519)(520)(521) y otras demencias (514)(515)(516) con la osteoporosis, o pérdida de densidad mineral ósea. Aunque no son tantos los que evalúan al eficacia de algún tipo de intervención.…”