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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2021

01-12-2021 | Care | Original Article

Clinical characteristics and outcomes of patients presenting with hip fractures at a tertiary care hospital in Pakistan

Authors: Ainan Arshad, Muhammad Talal Ibrahim, Hajra Arshad, Muhammad Bin Hammad, Sijal Akhtar Sheikh, Aysha Habib Khan, Lena Jafri, Sarah Nadeem

Published in: Archives of Osteoporosis | Issue 1/2021

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Abstract

Summary

Osteoporosis remains under-recognized and sub-optimally managed in Pakistan, with a lack of awareness that minimal impact hip fracture is a manifestation of low bone mineral density (BMD).

Purpose

Hip fracture is often the first clinical presentation of osteoporosis and an opportunity to intervene and reduce future fracture risk. Our aim was to understand the current practices in Pakistan related to bone health in patients presenting with a hip fracture.

Methods

This is a retrospective study at a tertiary care center in Pakistan of patients admitted with a hip fracture. Data collected includes previous fracture history, known preceding diagnosis of low BMD medication details, comorbidities, and DXA results.

Results

Two hundred ten patients were studied. The mean age of patients was 73.1 years, with 112 (53.3%) women. Most (195 (92.9%)) had presented with a low-impact hip fracture, with 17 (8.1%) reporting previous history of fracture. None had been treated with osteoporosis medications prior to fracture. Nineteen (9%) were on calcium and vitamin D supplements prior to fracture; of the minority who were screened, all were vitamin D deficient and subsequently discharged on vitamin D supplements. No one was prescribed medications to reduce fracture risk at discharge.

Conclusion

This study reveals that patients admitted with minimal impact hip fractures in Pakistan are rarely evaluated for low BMD and not started on osteoporosis medications even after presenting with a typical osteoporosis-related fracture. This underscores the need for health provider education about osteoporosis as a major cause for hip fractures and the need to intervene for future fracture risk reduction.
Literature
1.
Kanis JA (2019) Diagnosis and clinical aspects of osteoporosis. In: Pocket Reference to Osteoporosis. Springer, Berlin, pp 11–20CrossRef
2.
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767CrossRef
3.
Cosman F, de Beur SJ, LeBoff M, Lewiecki E, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25(10):2359–2381CrossRef
4.
on Osteoporosis NCDP, Prevention D (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285(6):785–795CrossRef
5.
Cadarette SM, Katz JN, Brookhart MA, Levin R, Stedman MR, Choudhry NK, Solomon DH (2008) Trends in drug prescribing for osteoporosis after hip fracture, 1995-2004. J Rheumatol 35(2):319–326PubMed
6.
Elliot-Gibson V, Bogoch E, Jamal S, Beaton D (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15(10):767–778CrossRef
7.
Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi J (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. In: Seminars in arthritis and rheumatism. Elsevier, Amsterdam, pp 293–305
8.
Rabenda V, Vanoverloop J, Fabri V, Mertens R, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster J-Y (2008) Low incidence of anti-osteoporosis treatment after hip fracture. JBJS 90(10):2142–2148CrossRef
9.
Nguyen E, Posas-Mendoza T, Siu A, Ahn H, Choi S, Lim S (2018) Low rates of osteoporosis treatment after hospitalization for hip fracture in Hawaii. Osteoporos Int 29(8):1827–1832CrossRef
10.
Mak JC, Cameron ID, March LM (2010) Evidence-based guidelines for the management of hip fractures in older persons: an update. Med J Aust 192(1):37–41CrossRef
11.
White S, Griffiths R, Holloway J, Shannon A (2010) Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network. Anaesthesia 65(3):243–248CrossRef
12.
Khan AH (2020) Osteoporosis in developing countries in Asia Pacific – challenges and opportunities. vol 2020. Asia Pacific Consortium on Osteoporosis (APCO),
13.
Ballane G, Cauley JA, Arabi A, Fuleihan GE-H (2013) Geographic variability in hip and vertebral fractures. In: Osteoporosis. Elsevier, pp 623–644
14.
Mithal A, Dhingra V, Lau E (2009) The asian audit: epidemiology, costs and burden of osteoporosis in Asia. Beizing, China: An International Osteoporosis Foundation (IOF) publication
15.
Habib S, Iqbal R, Shahid M, Habib A (2015) Growing prevalence of osteoporosis in Pakistan: call for action. J Pak Med Assoc 65(2):230–231PubMed
16.
Organization WH (2000) The Asia-Pacific perspective: redefining obesity and its treatment.
17.
Khan AH, Jafri L, Ahmed S, Noordin S (2018) Osteoporosis and its perspective in Pakistan: a review of evidence and issues for addressing fragility fractures. Annal Med Surg 29:19–25CrossRef
18.
Danish SH, Ahmad F, Hassan F, Khan SA, Hashmi AA, Muhammad S, Ali S, Liaquat SH (2014) Osteoporosis and its associated factors revisited: case control study. Pakist J Med Dent 3(02):13
19.
20.
Saad R, Beydoun M, Fuleihan GE-H (2019) Management of hip fractures at an academic center: challenges and opportunities. J Clin Densitom 23(4):524–533CrossRef
21.
Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, Harris ST, Hurley DL, Kelly J, Lewiecki EM (2020) American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis—2020 Update. Endocr Pract 26(s1):1–46CrossRef
22.
Weaver C, Alexander D, Boushey C, Dawson-Hughes B, Lappe JM, LeBoff M, Liu S, Looker A, Wallace T, Wang D (2016) Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 27(1):367–376CrossRef
23.
Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer PK, Lee SJ (2010) Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture: [See editorial comments by Dr. Robert A. Adler, pp 762–764]. J Am Geriatr Soc 58(4):650–657CrossRef
24.
Meyer AC, Hedström M, Modig K (2020) The Swedish Hip Fracture and National Patient Register were valuable for research on hip fractures: comparison of two registers. J Clin Epidemiol 125:91–99CrossRef
25.
The-World-Bank (2018) Life expectancy at birth, total (years).
26.
Papaioannou A, Kennedy CC, Ioannidis G, Gao Y, Sawka A, Goltzman D, Tenenhouse A, Pickard L, Olszynski W, Davison K (2008) The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19(4):581–587CrossRef
27.
Compston JE, Watts NB, Chapurlat R, Cooper C, Boonen S, Greenspan S, Pfeilschifter J, Silverman S, Díez-Pérez A, Lindsay R (2011) Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med 124(11):1043–1050CrossRef
28.
De Laet C, Kanis J, Odén A, Johanson H, Johnell O, Delmas P, Eisman J, Kroger H, Fujiwara S, Garnero P (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16(11):1330–1338CrossRef
29.
Nielson CM, Marshall LM, Adams AL, ES LB, Cawthon PM, Ensrud K, Stefanick ML, Barrett-Connor E, Orwoll ES, Group OFiMSR (2011) BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res 26(3):496–502CrossRef
30.
Dar FJ, Iqbal R, Ghani F, Siddiqui I, Khan AH (2012) Bone health status of premenopausal healthy adult females in Pakistani females. Arch Osteoporos 7(1-2):93–99CrossRef
31.
Khan AH, Naureen G, Iqbal R, Dar FJ (2013) Assessing the effect of dietary calcium intake and 25 OHD status on bone turnover in women in Pakistan. Arch Osteoporos 8(1-2):151CrossRef
32.
Toth E, Banefelt J, Åkesson K, Spångeus A, Ortsäter G, Libanati C (2020) History of previous fracture and imminent fracture risk in Swedish women aged 55 to 90 years presenting with a fragility fracture. J Bone Miner Res 35(5):861–868CrossRef
33.
Svenøy S, Watne LO, Hestnes I, Westberg M, Madsen JE, Frihagen F (2020) Results after introduction of a hip fracture care pathway: comparison with usual care. Acta Orthop 91(2):139–145CrossRef
34.
Ryan DJ, Yoshihara H, Yoneoka D, Egol KA, Zuckerman JD (2015) Delay in hip fracture surgery: an analysis of patient-specific and hospital-specific risk factors. J Orthop Trauma 29(8):343–348CrossRef
35.
Saul D, Riekenberg J, Ammon JC, Hoffmann DB, Sehmisch S (2019) Hip fractures: therapy, timing, and complication spectrum. Orthop Surg 11(6):994–1002CrossRef
36.
Nyholm AM, Gromov K, Palm H, Brix M, Kallemose T, Troelsen A, Paulsen AW, Petersen JK, Bloch T, Stentzer K (2015) Time to surgery is associated with thirty-day and ninety-day mortality after proximal femoral fracture: a retrospective observational study on prospectively collected data from the Danish Fracture Database Collaborators. JBJS 97(16):1333–1339CrossRef
37.
Rosso F, Dettoni F, Bonasia DE, Olivero F, Mattei L, Bruzzone M, Marmotti A, Rossi R (2016) Prognostic factors for mortality after hip fracture: operation within 48 hours is mandatory. Injury 47:S91–S97CrossRef
38.
Romero CC, Cordero ÁF, Santos JCS, Berenguer IP (2017) Relationship between vitamin D, osteoporotic fracture and falls. Med Clín (Engl Ed) 149(10):436–438
39.
Sheikh A, Saeed Z, Jafri SAD, Yazdani I, Hussain SA (2012) Vitamin D levels in asymptomatic adults-a population survey in Karachi, Pakistan. PLoS One 7(3):e33452CrossRef
40.
Riaz H, Finlayson A, Bashir S, Hussain S, Mahmood S, Malik F, Godman B (2016) Prevalence of vitamin D deficiency in Pakistan and implications for the future. Expert Rev Clin Pharmacol 9(2):329–338CrossRef
Metadata
Title
Clinical characteristics and outcomes of patients presenting with hip fractures at a tertiary care hospital in Pakistan
Authors
Ainan Arshad
Muhammad Talal Ibrahim
Hajra Arshad
Muhammad Bin Hammad
Sijal Akhtar Sheikh
Aysha Habib Khan
Lena Jafri
Sarah Nadeem
Publication date
01-12-2021
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-021-00895-9

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