Factors associated with receiving anti-osteoporosis treatment among older persons with minimal trauma hip fracture presenting to an acute orthogeriatric service

Bone health assessment in adults with fragility fracture risk factors between 2002-2014: a retrospective cohort study

BACKGROUND

Lifetime risk of fragility fractures is 50% in post-menopausal women and 20% in men aged >50 years. Identifying people at high risk facilitates early intervention and reduction of biopsychosocial morbidity associated with these fractures.

AIM

To explore if bone health assessment (BHA) rates differ between women and men aged ≥50 years with fragility fracture risk factors.

DESIGN & SETTING

A primary care-based cohort study in North Staffordshire, UK.

METHOD

Patients were identified from the Consultations in Primary Care Archive (CiPCA) database between 2002 and 2014 with one or more fragility fracture risk factors (previous fractures, falls, and prolonged steroid use). Evaluation of BHA within 12 months of presentation of the first risk factor was carried out by searching for codes for fracture risk assessment tools (FRAX and QFracture), bone density measurement, specialist service referral, or if bone-protection medication was started.

RESULTS

A total of 15 581 patients with risk factors were identified; men represented 40.4% of the cohort. The study found 1172 (7.5%) had BHA performed within 1 year of presentation, and 8.9% of women and 5.5% of men had BHAs, which was found with strong statistical evidence (χ2 = 59.88, P = 1 × 10-14). This relationship prevailed after adjusting for other covariates, such as comorbidity and number of consultations, with an odds ratio of 1.25 (95% confidence interval [CI] = 1.08 to 1.43).

CONCLUSION

This study has shown that rates of BHA were generally low and even lower in men compared with women. Primary care clinicians should be alert to fragility fracture risk factors in both men and women to enable early assessment and intervention.

Two-country comparison of the prescription of bone protection medication before and early after hip fracture

Pharmacological management of bone health warrants investigation into factors influencing initiation of bone protection medication (BPM) at discharge after a hip fracture. This sprint audit identified reasons attributed to low BPM treatment levels at hospital discharge which can guide improvement in the prevention of future fractures.

PURPOSE

To compare patient characteristics and Australian and New Zealand approaches to prescribing bone protection medication (BPM) pre- or post-hip fracture, determine reasons why BPM was not prescribed earlier post-fracture, and assess the generalisability of sprint audit and the Australian and New Zealand Hip Fracture Registry (ANZHFR) patient cohorts.

METHODS

A retrospective cohort study of hip fracture patients from the ANZHFR aged ≥ 50 years (2016-2020) and consecutive patients from the 2021 BPM sprint audit. Multivariable logistic regression was used to examine factors associated with not prescribing BPM.

RESULTS

Of 55,618 patients admitted with a hip fracture in the ANZHFR, less than 10% of patients in Australia and New Zealand were taking BPM on admission, increasing to 22.4% in Australia and 27.8% in New Zealand on discharge. Registry patients who were younger (50-69 years), healthy (ASA grade 1), lived in a residential aged care facility, had impaired cognition, delirium identified, or were awaiting a specialist falls assessment were less likely to take BPM. Within the audit, 46.2% of patients in Australia and 39.2% in New Zealand did not have BPM in their discharge prescription. The most common reason for not prescribing BPM in Australia was low level of vitamin D (13.3%), and in New Zealand, renal impairment (14.8%). Sprint and registry patient characteristics were comparable in terms of patient age, sex, usual place of residence, and ASA grade.

CONCLUSIONS

BPM prescription early after hip fracture is low. Opportunities exist to increase the rate of prescription of medications known to prevent future fractures in this high-risk population.

Uptake of osteoporosis treatment recommended by an orthogeriatrics service after hip fracture: Retrospective cohort study of prevalence and potential barriers and enablers at a tertiary referral hospital in Sydney

OBJECTIVES

The primary aim was to determine the 12-month period prevalence of and time to osteoporosis treatment following minimal trauma hip fractures in patients who were recommended treatment by an orthogeriatrics service. The secondary aim was to determine the factors associated with receiving treatment including the impact of osteoporosis clinic follow-up.

METHODS

A retrospective cohort study of patients with minimal trauma hip fractures admitted at a tertiary hospital in Sydney between 1 April 2017 and 31 March 2019 was performed. Baseline characteristics were collected from medical records. Osteoporosis treatment data were collected from patients and general practitioners. Univariate and multivariate logistic regression analyses were used to determine the factors associated with receiving osteoporosis treatment.

RESULTS

There were 189 participants who consented to participate with a mean age of 84.6 years. Most (76.7%) were females, 18.5% were nursing home residents, 70.9% had normal cognition, 20.6% were taking osteoporosis treatment prior to admission, 61.9% had osteoporosis treatment recommendations documented on the discharge summary, and 10.1% were followed up in the osteoporosis clinic. Ninety-eight patients (51.9%) received treatment within the first 12 months after fracture with a median time to treatment of 90 days. Factors associated with receiving osteoporosis treatment within 12 months on multivariate analysis included normal cognition (p = 0.03), taking osteoporosis treatment prior to admission (p < 0.001), including treatment recommendations in the discharge summary (p = 0.006) and osteoporosis clinic follow-up (p < 0.001).

CONCLUSIONS

Osteoporosis treatment after hip fracture remains suboptimal at this hospital. Patient and health service factors associated with treatment uptake could inform future quality improvement work.

Evaluation of the Implementation of Guidelines on the Treatment of Osteoporosis in Patients with Rheumatoid Arthritis

OBJECTIVE

To assess whether the 2003 and 2014 French guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) and the 2012 update of the French guidelines for the treatment of postmenopausal osteoporosis (PMOP) were applied in patients with rheumatoid arthritis (RA).

METHODS

We conducted a cross-sectional study of 776 patients with RA (19 centers). We collected the data required for the application of the various recommendations (age, sex, prednisone intake, low-energy fracture, history in the immediate family of hip fractures, and bone densitometry), anti-osteoporotic drugs, and the various factors that may be associated with the application of the recommendations.

RESULTS

Of the patients who should have received antiosteoporosis treatment, there were 22.6% actually treated (according to the 2014 guidelines), 27.3% actually treated according to the 2003 guidelines, and of postmenopausal women, 23.6% (according to the 2012 PMOP guidelines). Applying the 2014 GIOP guidelines increased the theoretical number of patients requiring treatment relative to the 2003 GIOP guidelines (77% vs 53%; p < 0.001). In multivariate analysis, being treated was associated with a spinal T score ≤ -2 SD according to the 2014 guidelines; with not taking part in physical activity for more than 30 min a day according to the 2003 guidelines; and with older age, lower body mass index, and a T score ≤ -2.5 SD in at least 1 site according to the PMOP guidelines.

CONCLUSION

Patients with RA had inadequate prevention of GIOP and PMOP. The management of osteoporosis needs to be improved in this population.