scholarly journals 91 Mrs Bad Bones: Impact of COVID-19 on Secondary Prevention of Fragility Fractures

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A Stephens ◽  
H Rudd ◽  
E Stephens ◽  
J Ward
Keyword(s):  
Vitamin D ◽  
Secondary Prevention ◽  
Fragility Fracture ◽  
Femur Fracture ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
Neck Of Femur ◽  
Calcium Supplements ◽  
Dexa Scan ◽  
Neck Of Femur Fracture

Abstract Introduction Management of osteoporosis is an important consideration for neck of femur fracture patients due to the morbidity and mortality it poses, and the significant financial burden to the NHS. Orthogeriatric teams input is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of healthcare teams and led to the redeployment of the orthogeriatricians to assist with the influx of medically unwell patients. This study explored the impact COVID-19 had on secondary fragility fracture prevention. Method A retrospective audit looking at the prescription of vitamin D/calcium supplements, bone-sparing medications, and DEXA scan requests in consecutive neck of femur fracture patients admitted to a trauma and orthopaedic unit pre- and post- UK lockdown in response to the pandemic. A re-audit was conducted following the implementation of our new mnemonic, “MRS BAD BONES”: Medication Review Rheumatology/Renal Advice Smoking Cessation Blood tests Alcohol limits DEXA scan Bone-sparing medications Orthogeriatric review Nutrition Exercise Supplements. Results Data for 50 patients was available in each phase. The orthogeriatric team reviewed 88% of patients pre-lockdown falling to 0% due to redeployment, before recovering to 38% in the post-intervention period. Upon lockdown there was a significant drop in the prescription of vitamin D/calcium supplements from 81.6% to 58.0% (p = 0.0156); of bone-sparing medications from 60.7% to 18.2% (p = 0.0037), and DEXA scan requests from 40.1% to 3.6% (p = 0.0027). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (p = 0.0034), bone-sparing medications to 72.4% (p = 0.0002) and DEXA scan requests to 60% (p < 0.0001). Conclusion COVID-19 had a major impact on the secondary prevention of fragility fractures in this population. The “MRS BAD BONES” mnemonic significantly improved the management and could be considered for use in a wider setting.

scholarly journals Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of “MRS BAD BONES” (Preprint)

2020 ◽  
Author(s):  
Alastair Stephens ◽  
Hannah Rudd ◽  
Emilia Stephens ◽  
Jayne Ward
Keyword(s):  
Vitamin D ◽  
Femoral Neck ◽  
Secondary Prevention ◽  
Fragility Fractures ◽  
Femoral Neck Fractures ◽  
Fisher Exact Test ◽  
Calcium Supplements ◽  
Dexa Scan ◽  
Retrospective Audit ◽  
The Impact

BACKGROUND Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. OBJECTIVE This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. METHODS A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, “MRS BAD BONES,” which addressed key factors in the assessment and management of osteoporosis: <i>m</i>edication review, <i>r</i>heumatology/renal advice, smoking cessation; <i>b</i>lood tests, <i>a</i>lcohol limits, <i>D</i>EXA (dual energy X-ray absorptiometry) scan; <i>b</i>one-sparing medications, <i>o</i>rthogeriatric review, <i>n</i>utrition, <i>e</i>xercise, supplements. The Fisher exact test was used for comparison analyses between each phase. RESULTS Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (<i>P</i>=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (<i>P</i>=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (<i>P</i>=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (<i>P</i>=.003), bone-sparing medications to 72.4% (n=21) (<i>P</i>&lt;.001), and DEXA scan requests to 60% (n=12) (<i>P</i>&lt;.001). CONCLUSIONS The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The “MRS BAD BONES” mnemonic significantly improved management and could be used in a wider setting. CLINICALTRIAL

scholarly journals Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of “MRS BAD BONES”

JMIR Aging ◽  
10.2196/25607 ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. e25607
Author(s):  
Alastair Stephens ◽  
Hannah Rudd ◽  
Emilia Stephens ◽  
Jayne Ward
Keyword(s):  
Vitamin D ◽  
Femoral Neck ◽  
Secondary Prevention ◽  
Fragility Fractures ◽  
Femoral Neck Fractures ◽  
Fisher Exact Test ◽  
Calcium Supplements ◽  
Dexa Scan ◽  
Retrospective Audit ◽  
The Impact

Background Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. Objective This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. Methods A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, “MRS BAD BONES,” which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase. Results Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (P=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (P=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (P=.003), bone-sparing medications to 72.4% (n=21) (P<.001), and DEXA scan requests to 60% (n=12) (P<.001). Conclusions The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The “MRS BAD BONES” mnemonic significantly improved management and could be used in a wider setting.

scholarly journals Secondary Prevention of Fragility Fractures: Are We Following the Guidelines?

2006 ◽  
Vol 88 (5) ◽  
pp. 470-474 ◽  
Author(s):  
N Prasad ◽  
D Sunderamoorthy ◽  
J Martin ◽  
JM Murray
Keyword(s):  
Vitamin D ◽  
Secondary Prevention ◽  
Nurse Practitioners ◽  
Blood Count ◽  
Fragility Fractures ◽  
Full Blood Count ◽  
Junior Doctors ◽  
Dexa Scan ◽  
Femur Fractures ◽  
Retrospective Audit

INTRODUCTION The aim of this study was to determine whether orthopaedic surgeons follow the British Orthopaedic Association (BOA) guidelines for secondary prevention of fragility fractures. PATIENTS AND METHODS A retrospective audit was conducted on patients with neck of femur fractures treated in our hospital between October and November 2003. A re-audit was conducted during the period August to October 2004. RESULTS There were 27 patients in the initial study period. Twenty-six patients (96%)had full blood count measured with LFT and bone-profile measured in 18 patients (66%). Only nine patients (30%)had treatment for osteoporosis (calcium and vitamin D). Only one patient was referred for DEXA scan. Steps were taken in the form of creating better awareness among the junior doctors and nurse practitioners of the BOA guidelines. In patients above 80 years of age, it was decided to use abbreviated mental score above 7 as a clinical criteria for DEXA referral. A hospital protocol based on BOA guidelines was made. A re-audit was conducted during the period August to October 2004. There were 37 patients. All had their full blood count and renal profile checked (100%). The bone-profile was measured in 28 (75.7%) and LFT in 34 (91.9%)patients. Twenty-four patients (65%) received treatment in the form of calcium + vitamin D (20) and bisphosphonate (4). DEXA-scan referral was not indicated in 14 patients as 4 were already on bisphosphonates and for 10 patients their abbreviated mental score was less than 7. Among the remaining 23 patients, 9 patients (40%) were referred for DEXA scan. This improvement is statistically significant (P = 0.03, chi square test). DISCUSSION AND CONCLUSIONS The re-audit shows that, although there is an improvement in the situation, we are still below the standards of secondary prevention of fragility fractures with 60% of femoral fragility fracture patients not being referred for DEXA scan. A pathway lead by a fracture liaison nurse dedicated to osteoporotic fracture patients should improve the situation.

152 The Relationship Between 25(OH) Vitamin D and Bone Mineral Density (BMD) in Patients 65 Years and Older with Prior Fragility Fractures

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
N Obiechina ◽  
A Michael ◽  
A Nandi ◽  
I Jameel ◽  
F Javed
Keyword(s):  
Vitamin D ◽  
Pearson Correlation ◽  
Positive Association ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
Mineral Density ◽  
Skeletal Health ◽  
Neck Of Femur ◽  
Cross Sectional ◽  
25 Oh Vitamin D

Abstract Introduction 25(OH) vitamin D [25(OH) D] levels are known to influence skeletal health as well as muscle function. Some studies suggest a positive association between 25(OH) D levels and BMD at various skeletal sites in men but not in women. These findings were mostly observed in younger (less than 50 year old) cohorts. Evidence for this association in older patients with prior fragility fractures is lacking. Aim: To assess the correlation of 25(OH) D levels with T-scores at the neck of femur, hip and spine in patients 65 years and older with prior fragility fractures and the effect of gender on the correlation. Methods A retrospective, cross-sectional analysis of patients 65 and older with previous fragility fractures in patients attending a fracture prevention service. Data was extracted from the electronic records. SPSS 26 statistical software was used for statistical analysis. Pearson correlation coefficient was used to calculate correlation and regression coefficient for gender. Results 151 patients were included; 26 males and 126 females. Mean age was 76.2 and 74.1 years respectively. In the males there was good positive, statistically significant correlation between the 25(OH) D and T-scores at the neck of femur (r = 0.415; p &lt; 0.05) and hip (r = 0.413; p &lt; 0.05), but correlation with T-score of the spine was not statistically significant (r = 0.349; p = 0.103). In the females there was no statistically significant correlation between 25(OH) D and T-scores at the neck of femur, hip or spine (r = 0.163; p = 0.077), (r = 0.096; p = 0.299) and (r = 0.114; p = 0.217) respectively. Conclusion In males, 65 years and older, with prior fragility fracture, there is a positive significant correlation between 25(OH) D and BMD at the neck of femur and hip whereas there is no significant correlation in females.

scholarly journals EVALUATION OF POST-SURGICAL MANAGEMENT OF FRAGILITY FRACTURES

2021 ◽  
Vol 29 (3) ◽  
pp. 137-142
Author(s):  
JOÃO CARLOS PEDRO FILHO ◽  
ROBERTO BEZERRA NICOLAU ◽  
RENATO WATONIKI OFFENBACHER ◽  
MARCOS VINICIUS CREDIDIO ◽  
FERNANDO BALDY DOS REIS ◽  
...  
Keyword(s):  
Vitamin D ◽  
Secondary Prevention ◽  
Comparative Study ◽  
Fragility Fracture ◽  
Calcium Supplementation ◽  
Fragility Fractures ◽  
Preventive Treatment ◽  
Level Of Evidence ◽  
Prospective Comparative Study ◽  
Fracture Surgery

ABSTRACT Objective: To evaluate the conduct of Brazilian orthopedists regarding preventive treatment after fragility fracture surgery. Methods: A questionnaire was applied to Brazilian orthopedists. Statistical analyses were performed using the SPSS 16.0 program. Results: 257 participants were analyzed. Most participants, 90.7% (n = 233), reported that they cared for patients with fractures and 62.3% (n = 160) treated them. The most indicated treatments were vitamin D (22.6%; n = 134) and calcium supplementation (21.4%; n = 127). According to the experience of the physicians - experienced (n = 184) and residents (n = 73) - fragility fractures were more common in the routine of residents (98.6%; n = 72) than experienced physicians (87.5%; n = 161), p = 0.0115. While treatment conduction was more reported by experienced physicians (63.6%; n = 117) than residents (58.9%; n = 43), p = 0.004. More experienced orthopedists (21.4%; n = 97) indicated treatment with bisphosphates than residents (14.2%; n = 20), p = 0.0266. Conclusion: Although most professionals prescribe treatment after fragility fracture surgery, about 40% of professionals still do not treat it, with differences in relation to experience. In this sense, we reinforce the importance of secondary prevention in the management of fragility fractures. Level of Evidence II, Prospective comparative study.

A MISSED DIAGNOSIS OF ASYMPTOMATIC SIMULTANEOUS BILATERAL FRACTURE NECK FEMUR DUE TO VITAMIN D DEFICIENCY TREATED AS SEVERE BILATERAL OSTEOARTHRITIS KNEE: HOW TO PREVENT IT?

2015 ◽  
Vol 18 (03) ◽  
pp. 1572002
Author(s):  
Prem Haridas Menon ◽  
Abhijeet Ashok Salunke ◽  
Diarmuid Paul Murphy ◽  
Shivendu Prosad Roy ◽  
M. K. Manoj ◽  
...  
Keyword(s):  
Vitamin D ◽  
Knee Joint ◽  
Vitamin D Deficiency ◽  
Femur Fracture ◽  
High Energy ◽  
Neck Of Femur ◽  
Fracture Neck Femur ◽  
Osteoarthritis Knee ◽  
Bilateral Fracture ◽  
Neck Of Femur Fracture

Simultaneous bilateral neck of femur fracture is a rare injury and poses a diagnostic challenge. This uncommon pattern of injury has been associated with high-energy trauma and seizure disorders. Proper clinical examination of both hip and knee joint should be performed in patients presenting with bilateral knee pain. Clinical suspicion and detailed radiologic evaluation of both hip and knee joint is essential for diagnosis of uncommon injury around hip joint. A battery of metabolic tests to assess vitamin D deficiency and histology study of the specimen should be performed. Patients with simultaneous bilateral fracture neck femur can be treated well and perform activities of daily living with good outcomes with prompt surgical intervention and medical treatment. We report the case of asymptomatic simultaneous bilateral neck of femur fracture following vitamin D deficiency which was missed and was misdiagnosed and treated for severe bilateral osteoarthritis knee.

Systematic approaches to fragility fracture prevention

2014 ◽  
Vol 23 (01) ◽  
pp. 39-44
Author(s):  
D. B. Lee ◽  
P. J. Mitchell
Keyword(s):  
Fragility Fracture ◽  
National Policy ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
The United States ◽  
Fracture Liaison Service ◽  
Reimbursement Mechanisms ◽  
Future Fracture ◽  
National Coalition ◽  
Fracture Liaison

SummaryIndividuals who have suffered fractures caused by osteoporosis – also known as fragility fractures – are the most readily identifiable group at high risk of suffering future fractures. Globally, the majority of these individuals do not receive the secondary preventive care that they need. The Fracture Liaison Service model (FLS) has been developed to ensure that fragility fracture patients are reliably identified, investigated for future fracture and falls risk, and initiated on treatment in accordance with national clinical guidelines. FLS have been successfully established in Asia, Europe, Latin America, North America and Oceania, and their widespread implementation is endorsed by leading national and international osteoporosis organisations. Multi-sector coalitions have expedited inclusion of FLS into national policy and reimbursement mechanisms. The largest national coalition, the National Bone Health Alliance (NBHA) in the United States, provides an exemplar of achieving participation and consensus across sectors. Initiatives developed by NBHA could serve to inform activities of new and emerging coalitions in other countries.

scholarly journals Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

2018 ◽  
Vol 9 ◽  
pp. 215145931878223 ◽  
Author(s):  
Andrew Davies ◽  
Thomas Tilston ◽  
Katherine Walsh ◽  
Michael Kelly
Keyword(s):  
Palliative Care ◽  
Femur Fracture ◽  
Trauma Centre ◽  
Care Plan ◽  
X Rays ◽  
Neck Of Femur ◽  
Early Palliative Care ◽  
Multidisciplinary Meeting ◽  
Major Trauma Centre ◽  
Neck Of Femur Fracture

Background: Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission. Objective: To investigate whether palliative care could be integrated early in the care plan for high-risk patients. Methods: All cases of inpatient mortality following neck of femur fracture at North Bristol Major Trauma Centre over a 24-month period were reviewed. A comprehensive assessment of care was performed from the emergency department until death. All investigations, interventions, and management decisions were recorded. A consensus decision regarding expected mortality was made for each case at a multidisciplinary meeting which included surgical, orthogeriatric, nursing, and anesthetic team input. Results: A total of 1033 patients were admitted following a neck of femur fracture. There were 74 inpatient deaths, and 82% were considered predictable at our multidisciplinary meeting. The mean length of stay was 18 days (range: 0-85, median 14). In 42% of cases, mortality was considered predictable on admission, and 40% were considered predictable following acute deterioration. These patients received on average 28 blood tests (range: 4-114) and 6.8 X-rays and computed tomographies (range: 2-20). Of this, 66% received end-of-life care; mean duration 2.3 days (range: 0-17). Conclusions: Mortality rates remain high in a subset of patients. This study demonstrates that intensive investigation and medical management frequently continues until death, including in patients with predictably poor outcomes. Early palliative care input has been integrated successfully into patient management in other specialties. We demonstrate that it is feasible to identify patients with hip fracture who may benefit from this expertise.

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