Bone Health Evaluations and Secondary Fragility Fractures in Hip Fracture Patients
4
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study sought to examine the utilization of bone health evaluations in geriatric hip fracture patients and identify risk factors for the development of future fragility fractures. Materials and Methods: A consecutive series of patients ≥55 years who underwent surgical management of a hip fracture between September 2015 and July 2019 were identified. Chart review was performed to evaluate post-injury follow-up, performance of a bone health evaluation, and use of osteoporosis-related diagnostic and pharmacologic treatment. Results: A total of 832 patients were included. The mean age of the patients was 81.2±9.9 years. Approximately 21% of patients underwent a comprehensive bone health evaluation. Of this cohort, 64.7% were started on pharmacologic therapy, and 73 patients underwent bone mineral density testing. Following discharge from the hospital, 70.3% of the patients followed-up on an outpatient basis with 95.7% seeing orthopedic surgery for post-fracture care. Overall, 102 patients (12.3%) sustained additional fragility fractures within two years, and 31 of these patients (3.7%) sustained a second hip fracture. There was no difference in the rate of second hip fractures or other additional fragility fractures based on the use of osteoporosis medications. Conclusion: Management of osteoporosis in geriatric hip fracture patients could be improved. Outpatient follow-up post-hip fracture is almost 70%, yet a minority of patients were started on osteoporosis medications and many sustained additional fragility fractures. The findings of this study indicate that orthopedic surgeons have an opportunity to lead the charge in treatment of osteoporosis in the post-fracture setting.
Abstract
Purpose: This study sought to examine the utilization of bone health evaluations in geriatric hip fracture patients and identify risk factors for the development of future fragility fractures. Materials and Methods: A consecutive series of patients ≥55 years who underwent surgical management of a hip fracture between September 2015 and July 2019 were identified. Chart review was performed to evaluate post-injury follow-up, performance of a bone health evaluation, and use of osteoporosis-related diagnostic and pharmacologic treatment. Results: A total of 832 patients were included. The mean age of the patients was 81.2±9.9 years. Approximately 21% of patients underwent a comprehensive bone health evaluation. Of this cohort, 64.7% were started on pharmacologic therapy, and 73 patients underwent bone mineral density testing. Following discharge from the hospital, 70.3% of the patients followed-up on an outpatient basis with 95.7% seeing orthopedic surgery for post-fracture care. Overall, 102 patients (12.3%) sustained additional fragility fractures within two years, and 31 of these patients (3.7%) sustained a second hip fracture. There was no difference in the rate of second hip fractures or other additional fragility fractures based on the use of osteoporosis medications. Conclusion: Management of osteoporosis in geriatric hip fracture patients could be improved. Outpatient follow-up post-hip fracture is almost 70%, yet a minority of patients were started on osteoporosis medications and many sustained additional fragility fractures. The findings of this study indicate that orthopedic surgeons have an opportunity to lead the charge in treatment of osteoporosis in the post-fracture setting.
참고문헌 (25)
- "What is osteoporosis and what causes it?"[URL]
- Kadri A, "Bone health optimization in orthopaedic surgery", J Bone Joint Surg Am, 102, pp.574~581 (2020)[DOI]
- Brauer CA, "Incidence and mortality of hip fractures in the United States", JAMA, 302, pp.1573~1579 (2009)[DOI]
- Tang VL, "Rates of recovery to prefracture function in older persons with hip fracture : an observational study", J Gen Intern Med, 32, pp.153~158 (2017)[DOI]
- Aguado-Maestro I, "Incidence of bone protection and associated fragility injuries in patients with proximal femur fractures", Injury, 48(Suppl 7), pp.S27~S33 (2017)[DOI]
- Kanis JA, "A meta-analysis of previous fracture and subsequent fracture risk", Bone, 35, pp.375~382 (2004)[DOI]
- Saxena A, "The NYU osteoporosis model of care experience", Geriatr Orthop Surg Rehabil, 6, pp.276~281 (2015)[DOI]
- Park CH, "Change of bone mineral density measurement among patients with osteoporotic fractures in Korean population using national claim database", J Bone Metab, 24, pp.183~186 (2017)[DOI]
- Cotts KG, "Treatment of osteoporosis", JAMA, 319, pp.1040~1041 (2018)[DOI]
- Anderson PA, "Bone health optimization : beyond own the bone : AOA critical issues", J Bone Joint Surg Am, 101, pp.1413~1419 (2019)[DOI]
- Oh YK, "Management of osteoporosis medication after osteoporotic fracture", Hip Pelvis, 34, pp.191~202 (2022)[DOI]
- Balasubramanian A, "Declining rates of osteoporosis management following fragility fractures in the U. S., 2000 through 2009", J Bone Joint Surg Am, 96, pp.e52~ (2014)[DOI]
- Solomon DH, "Underuse of osteoporosis medications in elderly patients with fractures", Am J Med, 115, pp.398~400 (2003)[DOI]
- Kim JW, "Factors affecting bone mineral density measurement after fracture in South Korea", J Bone Metab, 24, pp.217~222 (2017)[DOI]
- "Own the bone:what is own the bone?"[URL]
- Bunta AD, "Own the bone, a system-based intervention, improves osteoporosis care after fragility fractures", J Bone Joint Surg Am, 98, pp.e109~ (2016)[DOI]
- Levitt EB, "Barriers and resources to optimize bone health in orthopaedic education : own the bone(OTB) : bone health education in residency", JB JS Open Access, 6, pp.e21.00026~ (2021)[DOI]
- Edwards BJ, "Addressing secondary prevention of osteoporosis in fracture care: follow-up to "own the bone."", J Bone Joint Surg Am, 93, pp.e87~ (2011)[DOI]
- "Own the bone:highlighting own the bone"[URL]
- Bogoch ER, "Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment", J Bone Joint Surg Am, 88, pp.25~34 (2006)
- Elliot-Gibson V, "Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture : a systematic review", Osteoporos Int, 15, pp.767~778 (2004)[DOI]
- Hawker G, "The impact of a simple fracture clinic intervention in improving the diagnosis and treatment of osteoporosis in fragility fracture patients", Osteoporos Int, 14, pp.171~178 (2003)[DOI]
- Malik AT, "The"hip fracture"bundle-experiences, challenges, and opportunities", Geriatr Orthop Surg Rehabil, 11, pp.2151459320910846~ (2020)[DOI]
- Lim JY, "Fracture liaison service in Korea : 2022 position statement of the Korean Society for Bone and Mineral Research", J Bone Metab, 30, pp.31~36 (2023)[DOI]
- Lönnroos E, "Incidence of second hip fractures. A populationbased study", Osteoporos Int, 18, pp.1279~1285 (2007)[DOI]