Improving care after hip fracture: the fracture? Think osteoporosis (FTOP) program

Abstract

BackgroundHip fractures are a common and serious consequence of osteoporosis, and hip fracture patients are at high risk for recurrence. Appropriate pharmacotherapy reduces this risk and is associated with reduced mortality after hip fracture, but a care gap exists for fracture prevention in these patients. This evaluation determined rates of osteoporosis treatment and bone mineral density (BMD) testing in hip fracture patients following discharge from a rehabilitation unit.MethodsA prospective cohort study of hip fracture patients aged ≥ 50 on an inpatient rehabilitation unit in 2008 and 2011. Patients were seen by a nurse specialist, and encouraged to see their family physician for further assessment and treatment. Physicians were sent a letter indicating the need to follow up with their patient. Patients were contacted following discharge from hospital to determine treatment rates.ResultsOf 310 eligible hip fracture patients admitted to the rehabilitation unit in the years studied, 207 patients were reached post-discharge and provided data. Of patients who were not previously taking osteoporosis medication, 59% of patients from the 2008 cohort, and 42% of patients from the 2011 cohort had osteoporosis treatment initiated by six months following discharge. By 2 months following discharge, 46% of patients in the 2008 cohort had a new BMD performed or scheduled, while this was true for 14% of patients from the 2011 cohort. 35% of patients in 2011 had not seen their family physician by 2 months following discharge.ConclusionsRates for osteoporosis treatment and BMD testing were higher than those reported in the literature for patients not enrolled in case manager programs. BMD testing declined from 2008 to 2011. Lower treatment rates may be due to concerns regarding reports of possible association between bisphosphonate use and atypical fractures. Improving rates of patient follow-up with family physicians will be important for increasing hip fracture treatment rates after discharge.

Fraturas de fêmur em idosos no Brasil: análise espaço-temporal de 2008 a 2012

“…Sua prevalência tem aumentado em função do crescimento da população idosa e das mudanças no comportamento humano, tais como diminuição da ingestão de cálcio, sedentarismo, alcoolismo e tabagismo 34 . A osteoporose é o principal fator de risco para fraturas ósseas em idosos, especialmente as que acometem ossos longos, como o fêmur, tanto as ocasionadas por traumatismos quanto as de ocorrência espontânea 10 . Segundo Pinto Neto et al 35 , 90% das fraturas de fêmur e quadril na osteoporose ocorrem em razão de quedas, e o restante em consequência de movimentos de torção do fê-mur com queda consequente.…”

“…Dentre as fraturas, as mais comuns são as de fêmur 9 para as quais a osteoporose é um importante fator de risco 10 , justificando sua maior ocorrência entre as mulheres com idade igual ou superior a 60 anos 11,12 . Os números relativos a esse problema refletem sua importância em algumas partes do mundo.…”

Seasonal variation of femoral fractures in the state of São Paulo, Southeast Brazil

“…In the age group of 60–69 years the incidence is similar between men and women, and after the age of 70 years, the incidence is much higher among women than among men. The number of fractures that are due to osteoporosis can explain these differences 3 .…”

“…Femoral fractures are a common cause of mortality and functional loss, mainly among older people 1 , 2 . Osteoporosis is one of the main risk factors for these fractures 3 , and other known risk factors are falls, early menopause, and sedentary lifestyle 1–4 . It is estimated that the life expectancy of patients suffering from femoral fracture is reduced from 15% to 20% 4 .…”

Evaluation of a multidisciplinary rehabilitation programme for elderly patients with hip fracture: A prospective cohort study

“…The importance of physicians in post-fracture treatment, i.e. osteoporosis screening and treatment, was also addressed in some literature (32).…”