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01-12-2022 | Osteoporosis | Original Article

Challenges in osteoporosis treatment initiation in geriatric patients admitted under the hip-fracture pathway

Authors: Angela Frances Yap Hui Wen, Bernard Yap Kok Chong, Lissa Vazhayil Joseph, Joyce Koh Suang Bee, Howe Tet Sen, Kaysar Mamun

Published in: Archives of Osteoporosis | Issue 1/2022

Abstract

Summary

Osteoporosis is often untreated especially in older people. This study found a low prescribing rate of osteoporosis treatment medication of 22.4% in older people admitted under the hip-fracture pathway. Factors associated with greater odds of being prescribed osteoporosis medications are categorized into patient-related, physician-related and system-related factors.

Introduction

Osteoporosis represents a growing healthcare problem which is often overlooked by healthcare providers and untreated especially in older people. This study aims to assess the rate of osteoporosis treatment initiation and to investigate underlying physician and system-related barriers in geriatric patients admitted for hip fracture.

Methods

A retrospective study was conducted on patients aged 60 years and older, admitted under the hip-fracture pathway from January 2019 to December 2019. Data collected included demographics, co-morbid conditions and laboratory data. Clinical charts were reviewed for whether bone mineral density (BMD) scan has been ordered, plans for bone health were made and reflected in the discharge summary, and if appropriate memos were written. The primary outcome was the prescription of osteoporosis treatment medications. Prescription lists were also reviewed for prescribing patterns of calcium and vitamin D.

Results

A total of 375 patients older than 60 years old were identified. 281 patients who fit the inclusion and exclusion criteria with complete data were further analysed. Within 1 year of hip fracture admission, 63 (22.4%) of them were prescribed with osteoporosis treatment. Multivariate logistic regression identified milder stage of CKD (p = 0.038, OR = 0.617, 95% CI 0.392–0.973) and BMD scan performed (p < 0.001, OR = 6.515, 95% CI 3.180–13.348) as independent factors associated with the prescription of osteoporosis treatment within 1 year of hip fracture admission.

Conclusion

The rate of osteoporosis treatment initiation post-hip fracture is low. Systematic solutions will need to be established to ensure that osteoporosis treatment is addressed prior to discharge.

Sözen T, Özışık L, Başaran NÇ (2017) An overview and management of osteoporosis. Eur J Rheumatol 4(1):46–56. https://doi.org/10.5152/eurjrheum.2016.048CrossRefPubMed

Gardner MJ, Flik KR, Mooar P, Lane JM (2002) Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am 84(8):1342–1348. https://doi.org/10.2106/00004623-200208000-00008CrossRefPubMed

Teng GG, Curtis JR, Saag KG (2009) Quality health care gaps in osteoporosis: how can patients, providers, and the health system do a better job? Curr Osteoporos Rep 7(1):27–34. https://doi.org/10.1007/s11914-009-0006-3CrossRefPubMed

Lisk R, Yeong K (2014) Reducing mortality from hip fractures: a systematic quality improvement programme. BMJ Qual Improv Rep 3(1):u205006.w2103. https://doi.org/10.1136/bmjquality.u205006.w2103CrossRefPubMedPubMedCentral

Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos. Int J Establ Result Coop Eur Found Osteoporos. Natl Osteoporos Found USA 7(5):407–413. https://doi.org/10.1007/pl00004148

Cummings SR et al (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361(8):756–765. https://doi.org/10.1056/NEJMoa0809493CrossRefPubMed

Colón-Emeric C et al (2011) Association between timing of zoledronic acid infusion and hip fracture healing. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found. USA 22(8):2329–2336. https://doi.org/10.1007/s00198-010-1473-1

Kim SC et al (2015) Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study. Am J Med 128(5):519-526.e1. https://doi.org/10.1016/j.amjmed.2015.01.014CrossRefPubMedPubMedCentral

Chau YT, Nashi N, Law LS-C, Goh RKH, Choo SX, Seetharaman SK (2020) Undertreatment of osteoporosis following hip fracture: a retrospective, observational study in Singapore. Arch Osteoporos 15(1):141. https://doi.org/10.1007/s11657-020-00816-2CrossRefPubMed

10.

Byszewski A, Lemay G, Molnar F, Azad N, McMartin SE (2011) Closing the osteoporosis care gap in hip fracture patients: an opportunity to decrease recurrent fractures and hospital admissions. J Osteoporos 2011:404969. https://doi.org/10.4061/2011/404969CrossRefPubMedPubMedCentral

11.

Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res Off J Am Soc Bone Miner Res 29(9):1929–1937. https://doi.org/10.1002/jbmr.2202

12.

Desai RJ et al (2018) Association of osteoporosis medication use after hip fracture with prevention of subsequent nonvertebral fractures: an instrumental variable analysis. JAMA Netw Open 1(3):e180826. https://doi.org/10.1001/jamanetworkopen.2018.0826CrossRefPubMedPubMedCentral

13.

Kung AW et al (2013) Factors influencing diagnosis and treatment of osteoporosis after a fragility fracture among postmenopausal women in Asian countries: a retrospective study. BMC Womens Health 13:7. https://doi.org/10.1186/1472-6874-13-7CrossRefPubMedPubMedCentral

14.

Chandran M, Tan MZW, Cheen M, Tan SB, Leong M, Lau TC (2013) Secondary prevention of osteoporotic fractures--an ‘OPTIMAL’ model of care from Singapore. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 24(11):2809–2817. https://doi.org/10.1007/s00198-013-2368-8

15.

Hallock A (2017) Osteoporosis in patients with CKD: a diagnostic dilemma. Nephrol Nurs J J Am Nephrol Nurses Assoc 44(1):13–17

16.

Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T (2003) Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med 163(18):2165–2172. https://doi.org/10.1001/archinte.163.18.2165CrossRefPubMed

17.

Feldstein AC et al (2005) The near absence of osteoporosis treatment in older men with fractures. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 16(8):953–962. https://doi.org/10.1007/s00198-005-1950-0

18.

Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 162(19):2217–2222. https://doi.org/10.1001/archinte.162.19.2217CrossRefPubMed

19.

Kuijpers MAJ, van Marum RJ, Egberts ACG, Jansen PAF, OLDY (OLd people Drugs & dYsregulations) Study Group (2008) Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 65(1):130–133. https://doi.org/10.1111/j.1365-2125.2007.02961.x

20.

Majumdar SR et al (2014) Critical impact of patient knowledge and bone density testing on starting osteoporosis treatment after fragility fracture: secondary analyses from two controlled trials. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 25(9):2173–2179. https://doi.org/10.1007/s00198-014-2728-z

21.

Brask-Lindemann D, Cadarette SM, Eskildsen P, Abrahamsen B (2011) Osteoporosis pharmacotherapy following bone densitometry: importance of patient beliefs and understanding of DXA results. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 22(5):1493–1501. https://doi.org/10.1007/s00198-010-1365-4

22.

Yu J, Brenneman SK, Sazonov V, Modi A (2015) Reasons for not initiating osteoporosis therapy among a managed care population. Patient Prefer Adherence 9:821–830. https://doi.org/10.2147/PPA.S81963CrossRefPubMedPubMedCentral

23.

van den Bergh JPW, Bours SPG, van Geel TACM, Geusens PP (2011) Optimal use of vitamin d when treating osteoporosis. Curr Osteoporos Rep 9(1):36–42. https://doi.org/10.1007/s11914-010-0041-0CrossRefPubMed

24.

Kim S-R, Ha Y-C, Park Y-G, Lee S-R, Koo K-H (2011) Orthopedic surgeon’s awareness can improve osteoporosis treatment following hip fracture: a prospective cohort study. J Korean Med Sci 26(11):1501–1507. https://doi.org/10.3346/jkms.2011.26.11.1501CrossRefPubMedPubMedCentral

25.

Barton DW, Smith CT, Piple AS, Moskal SA, Carmouche JJ (2020) Timing of bisphosphonate initiation after fracture: what does the data really say? Geriatr Orthop Surg Rehabil 11:2151459320980369. https://doi.org/10.1177/2151459320980369CrossRefPubMedPubMedCentral

26.

Holick MF et al (2005) Prevalence of Vitamin D Inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90(6):3215–3224. https://doi.org/10.1210/jc.2004-2364CrossRefPubMed

27.

Nurmi-Lüthje I et al (2009) Post-fracture prescribed calcium and vitamin D supplements alone or, in females, with concomitant anti-osteoporotic drugs is associated with lower mortality in elderly hip fracture patients: a prospective analysis. Drugs Aging 26(5):409–421. https://doi.org/10.2165/00002512-200926050-00005CrossRefPubMed

28.

Van Camp L, Dejaeger M, Tournoy J, Gielen E, Laurent MR (2020) Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-analysis. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 31(11):2083–2092. https://doi.org/10.1007/s00198-020-05512-y

29.

Raybould G, Babatunde O, Evans AL, Jordan JL, Paskins Z (2018) Expressed information needs of patients with osteoporosis and/or fragility fractures: a systematic review. Arch Osteoporos 13(1):55. https://doi.org/10.1007/s11657-018-0470-4CrossRefPubMedPubMedCentral

30.

Gerstenfeld LC et al (2009) Comparison of effects of the bisphosphonate alendronate versus the RANKL inhibitor denosumab on murine fracture healing. J Bone Miner Res 24(2):196–208. https://doi.org/10.1359/jbmr.081113CrossRefPubMed

31.

Kim T-Y, Ha Y-C, Kang B-J, Lee Y-K, Koo K-H (2012) Does early administration of bisphosphonate affect fracture healing in patients with intertrochanteric fractures? J Bone Joint Surg Br 94(7):956–960. https://doi.org/10.1302/0301-620X.94B7.29079CrossRefPubMed

Title: Challenges in osteoporosis treatment initiation in geriatric patients admitted under the hip-fracture pathway
Authors: Angela Frances Yap Hui Wen
Bernard Yap Kok Chong
Lissa Vazhayil Joseph
Joyce Koh Suang Bee
Howe Tet Sen
Kaysar Mamun
Publication date: 01-12-2022
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Chronic Kidney Disease
Published in: Archives of Osteoporosis / Issue 1/2022
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-022-01179-6

At a glance: The STEP trials

Springer Medicine

Challenges in osteoporosis treatment initiation in geriatric patients admitted under the hip-fracture pathway

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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