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01-12-2020 | Osteoporosis | Original Article

Management of hospitalised osteoporotic vertebral fractures

Authors: Cunningham Caitriona, Mc Gowan Mark, Hughes Elaine, Gallagher Claire, Fitzgerald Michelle, Ulrik McCarthy Persson, Cathie Sherrington, Catherine Blake

Published in: Archives of Osteoporosis | Issue 1/2020

Abstract

Summary

Management of hospitalised osteoporotic vertebral fracture patients was explored across all major trauma orthopaedic hospitals in Ireland. Findings, based on a survey of orthopaedic doctors and physiotherapists, indicate a lack of standardised clinical care pathways. This study will inform development of clinical audit mechanisms and health service development for this large and growing fracture population in both Ireland and internationally.

Purpose

To explore the management of hospitalised vertebral fragility fracture (VFF) patients in Ireland.

Methods

A cross-sectional survey of orthopaedic doctors (specialist registrar level) and physiotherapists was conducted across all hospitals with major orthopaedic trauma units in Ireland. Data were analysed using descriptive statistics in SPSS (V24).

Results

Responses were achieved from 100% (n = 16) of the hospitals (42 individual physiotherapists and 47 orthopaedic doctors). Conservative management was usual with both orthopaedic doctors (n = 37, 79%) and physiotherapists (n = 40, 96%) reporting prescription of bracing as common practice despite a lack of underpinning evidence. A majority (87%) of the doctors believed osteoporosis medications should commence prior to discharge from the acute setting, but 68% did not agree that responsibility for coordination and delivery of bone health assessment and fracture risk management rested with them. A majority (72%) of physiotherapists reported an absence or were unsure regarding existence of fracture liaison services. 73% of physiotherapists reported prescribing an inpatient or home (78%) exercise programme, including mobility, strength and balance exercise though detail on dose and adherence remain unknown. Wide variance in referral patterns to multi-disciplinary team (MDT) members existed although 79% of orthopaedic doctors supported an MDT approach.

Conclusion

Clinical care pathways for the hospitalised VFF population lack standardisation in Ireland. Key challenges reported by orthopaedic doctors and physiotherapists relate to pain management, osteoporosis medication prescription, clarity on indications for bracing and a lack of fracture liaison services. Clinical guidelines, defined clinical care pathways and high-quality clinical research trials are required for VFF management.

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Title: Management of hospitalised osteoporotic vertebral fractures
Authors: Cunningham Caitriona
Mc Gowan Mark
Hughes Elaine
Gallagher Claire
Fitzgerald Michelle
Ulrik McCarthy Persson
Cathie Sherrington
Catherine Blake
Publication date: 01-12-2020
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Archives of Osteoporosis / Issue 1/2020
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-020-0687-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Management of hospitalised osteoporotic vertebral fractures

Abstract

Summary

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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