Usefulness of a national hip fracture registry to evaluate the profile of patients in whom antiosteoporotic treatment is prescribed following hospital discharge

Abstract

This study was carried out to describe the profile of prescription of antiosteoporotic treatment at discharge after a hip fracture in the Spanish National Hip Fracture Registry. Prescription rates among hospitals ranged from 0 to 94% of patients discharged. The prescription rate was higher among patients with better cognitive and functional baseline status. Purpose National hip fracture registries are useful for assessing current care processes. The goals of this study were as follows: first, to know the rate of antiosteoporotic prescription at discharge among hip fracture patients in hospitals participating in the Spanish National Hip Fracture Registry (RNFC); second, to compare the differences between treated and non-treated patients; third, to analyze patients' characteristics associated with antiosteoporotic prescription at discharge; and fourth, to evaluate whether there were differences in the profile of patients discharged from hospitals with high and low prescription rates. Method Patients discharged after a fragility hip fracture in 2017 and participating in the RNFC were included. Demographic variables, cognitive and functional status, prefracture osteoporosis treatment, fracture type, anesthetic risk, hospital volume, and antiosteoporotic prescription at discharge were analyzed. Given that patients were clustered within hospitals, intraclass correlation was calculated and generalized estimating equations were fitted. Results A total of 6701 patients from 54 hospitals were included. Antiosteoporotic prescription at discharge was prescribed to 36.5% (CI95% 35.8-37.2%), with a wide inter-hospital variability (range 0-94%). The intraclass correlation due of clustering of patients within hospitals was 47.9%. Antiosteoporotic prescription was more likely in patients who were younger, lived at home, previously treated for osteoporosis, had better baseline functional and cognitive status, lower anesthetic risk, and were discharged from high-volume hospitals, all with p < 0.001. The general profile of patients discharged from hospitals with high and low rate of prescription was similar. Conclusions There is a wide variability between hospitals regarding antiosteoporotic prescription after hip fracture. This is more likely to be initiated in patients with better clinical, functional, and mental status and in those discharged from hospitals with larger volumes of patients. These results offer insights regarding the selection of patients receiving secondary prevention and raises questions on who and how many should be treated.

Time to surgery after proximal femur fracture in geriatric patients depends on hospital size and provided level of care: analysis of the Registry for Geriatric Trauma (ATR-DGU)

“…Regarding initiation of osteoporosis therapy, higher frequency was observed in level I trauma centers. These findings match with an evaluation of the Spanish Hip Fracture Registry by Alarcon et al, where anti-osteoporotic therapy was prescribed significantly more often at high-volume hospitals [ 24 ]. Furthermore, Kristensen et al found that interventions to prevent future falls were taken more frequently at high-volume hospitals [ 18 ].…”

Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region

“…Benchmarking of care for secondary prevention of fragility fractures is a component of the IOF Capture the Fracture® program [40], and of national fracture liaison service standards based on the 5IQ model [7][8][9]. Hip fracture registries, that have been established in several countries, also enable benchmarking of acute perioperative care and secondary fracture prevention after hip fracture [41][42][43][44][45][46].…”