scholarly journals 279 Quality Improvement Audit on Bone Health Assessment and Secondary Prevention of Patients Discharged from an In-patient Rehabilitation Unit Post Fracture

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Pádraig Synnott ◽  
Michelle Brennan ◽  
Shaun O'Keeffe ◽  
Michelle Canavan
Keyword(s):  
Vitamin D ◽  
Bone Health ◽  
Health Assessment ◽  
Pharmacological Therapy ◽  
Prescribing Practices ◽  
Antiresorptive Therapy ◽  
Rehabilitation Unit ◽  
Life Years ◽  
Fracture Bone ◽  
Site Rehabilitation

Abstract Background Osteoporosis accounts for more disability-adjusted life years than many non-communicable diseases. Identification and treatment is important to reduce morbidity and mortality associated with further fracture.(1) National Osteoporosis Guideline Group recommends all patients with a fragility fracture should undergo a bone health assessment and commence pharmacological therapy if indicated.(2) Methods Electronic discharge summaries of all patients with a diagnosis of fracture discharged from an off-site rehabilitation unit from 1st January 2018 to 31st December 2018 were reviewed. Patient details, location and mechanism of fracture, bone health assessment and discharge prescription were assessed. Following data collection, an education session directed at NCHDs was performed and a discharge checklist prompting bone health review and consideration of pharmacological therapy was introduced. A re-audit was performed at 4 months to assess change following this intervention. Results 74 patients had a diagnosis of fracture. 4 were excluded as fracture resulted from high impact trauma. 100% had corrected calcium measured. 93%(n=65) had Vitamin D(OH) measured. 91%(n=64) had PTH measured. 55%(n=39) were discharged on calcium/vitamin D(OH) supplementation. 33%(n=23) were discharged on Vitamin D(OH) alone. 66%(n=46) were discharged on antiresorptive therapy: 28%(n=13) bisphosphonate, 67% (n=31) denosumab, 4% others. 33%(n=23) were not prescribed any bone protection on discharge. 4 had advanced chronic kidney disease. 6%(n=4) were discharged without calcium/Vitamin D or antiresorptive therapy. A re-audit from January to April 2019 of 15 patients post NCHD education has shown an increase in antiresorptive therapy prescription 86%(n=13) Conclusion Bone health assessment and prescribing practices of antiresorptive therapy in patients undergoing rehabilitation post fracture is sub-optimal. Education of non-consultant hospital doctors can substantially improve rates of antiresorptive therapy prescription.

scholarly journals 327 The Impact of Implementation of Recommendations from the IFHD 2017 Annual Report in an Irish Model 3 Hospital

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Siofra Hearne ◽  
Hannah Smyth ◽  
Pheadra Monahan ◽  
Hugh McGowan ◽  
Shirley Timmins ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Bone Health ◽  
Annual Report ◽  
Health Assessment ◽  
Admission Rate ◽  
Rehabilitation Services ◽  
Discharge Destination ◽  
Older Person ◽  
Site Rehabilitation ◽  
The Impact

Abstract Background Hip fractures in the older person are associated with high mortality rates (NICE, 2011). Up to 40% of patients never regain their pre-fracture mobility, 10-20% never return to live at home. The Irish Hip Fracture Database (IHFD) National Report 2017 recommends appointment of an orthogeriatric consultant in this hospital to achieve IHFD standards 4 to 6. Methods We analysed a subset of HIPE data collected for the IHFD in patients over 60 years over a three month period from September – November 2017 and compare it to September – November 2018 after introduction of an orthogeriatric service. We looked at geriatrician review, bone health assessment, falls assessment, discharge destination, 30-day re-admission rate and mortality during admission. Results There were 45 hip fracture patients in each group. In the 2017 group, mean age was 79, female 64%; compared to mean age of 80, female 62.2% in 2018. In 2018, after the appointment of an orthogeriatrician, 95.6% of patients were seen by a geriatrician compared to 4.4% in 2017. In 2018, 97.7% received bone health assessment compared to 26.8% in 2017. In 2018 95.3% received specialist falls assessment, compared to 2.4% in 2017. Mean length of stay was 18 days in 2018 versus 13 days in 2017. 2.2% of patients were discharged to convalescence in 2018, 26.7% in 2017. 57.8% of patients were discharged to off-site rehabilitation in 2018 compared to 40% in 2017. 2.2% patients died during admission in 2018, 8.9% in 2017. In 2018, 6.7% of patients were readmitted within 30 days, 8.8% in 2017. Conclusion Provision of rapid Comprehensive Geriatric Assessment to all hip fracture patients, reduces falls and fracture risk. There is evidence of improvement in IHFD standards 4-6, mortality rate and 30-day readmission rate. Moreover, the orthogeriatric service has led to increased referral to rehabilitation services ensuring optimal functional recovery.

scholarly journals A Missed Opportunity in Bone Health: Vitamin D and Calcium Use in Elderly Femoral Neck Fracture Patients Following Arthroplasty

2017 ◽  
Vol 8 (4) ◽  
pp. 215-224 ◽  
Author(s):  
Sheila Sprague ◽  
Kim Madden ◽  
Gerard Slobogean ◽  
Brad Petrisor ◽  
Jonathan D. (Rick) Adachi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Fragility Fracture ◽  
Bone Health ◽  
Health Management ◽  
Multinomial Regression ◽  
Prescribing Practices ◽  
Supplement Use ◽  
Neck Fracture ◽  
Using Data

Introduction: Introduction: Adequate calcium and vitamin D from diet and supplementation is recommended for elderly hip fracture patients. Using data from the multinational hip fracture arthroplasty trial (HEALTH), we determined the proportion of patients who consistently took vitamin D and calcium and which characteristics/prescribing practices were associated with consistency of supplement use. Methods: HEALTH is a multicenter randomized trial of elderly hip fracture patients treated with hemi-arthroplasty and total hip arthroplasty. Patients were categorized as consistent users, inconsistent users, or nonusers of calcium and vitamin D. We used multinomial regression to determine the characteristics associated with calcium and vitamin D use. Results: 603 HEALTH participants were included in the analysis. 34.7% of patients never took vitamin D within 12 months after surgery, 26.2% took vitamin D inconsistently, and 39.1% took vitamin D consistently. 36.0% of patients never took calcium within 12 months after surgery, 28.4% took calcium inconsistently, and 35.7% took calcium consistently. There was great variation in prescribed/recommended doses. Compared to nonusers, consistent users of the supplements were more likely to be female, North American, prescribed/recommended vitamin D and/or calcium postoperatively, and presented to a facility with comprehensive fragility fracture protocols. Conclusions: A low proportion of elderly hip fracture patients are consistently taking vitamin D and calcium, which may contribute to poorer bone health. Surgeons should be educated to prescribe/ recommend vitamin D and calcium, institutions should develop comprehensive fragility fracture protocols and patient education strategies to ensure that patients with osteoporosis receive bone health management beyond fracture care.

Vitamin D status and bone health in survivors of childhood lymphoblastic leukemia

2013 ◽  
Author(s):  
M Schundeln Michael ◽  
K Hauffa Pia ◽  
C Goretzki Sara ◽  
Lahner Harald ◽  
Marschke Laura ◽  
...  
Keyword(s):  
Vitamin D ◽  
Bone Health ◽  
Lymphoblastic Leukemia ◽  
Vitamin D Status

Vitamin D in Basketball Players: Current Evidence and Future Directions

2021 ◽  
pp. 194173812110193
Author(s):  
Emilija Stojanović ◽  
Dragan Radovanović ◽  
Tamara Hew-Butler ◽  
Dušan Hamar ◽  
Vladimir Jakovljević
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Body Composition ◽  
Physical Performance ◽  
Bone Health ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Current Evidence ◽  
Basketball Players ◽  
Level Of Evidence

Context: Despite growing interest in quantifying and correcting vitamin D inadequacy in basketball players, a critical synthesis of these data is yet to be performed to overcome the low generalizability of findings from individual studies. Objective: To provide a comprehensive analysis of data in basketball pertaining to (1) the prevalence of vitamin D inadequacy; (2) the effects of vitamin D supplementation on 25-hydroxyvitamin D [25(OH)D] concentration (and its association with body composition), bone health, and performance; and (3) crucial aspects that warrant further investigation. Data Sources: PubMed, MEDLINE, ERIC, Google Scholar, SCIndex, and ScienceDirect databases were searched. Study Selection: After screening, 15 studies were included in the systematic review and meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3. Data Extraction: The prevalence of vitamin D inadequacy, serum 25(OH)D, body composition, stress fractures, and physical performance were extracted. Results: The pooled prevalence of vitamin D inadequacy for 527 basketball players in 14 studies was 77% ( P < 0.001; 95% CI, 0.70-0.84). Supplementation with 4000 IU/d and 4000 IU/wk (absolute mean difference [AMD]: 25.39 nmol/L; P < 0.001; 95% CI, 13.44-37.33), as well as 10,000 IU/d (AMD: 100.01; P < 0.001; 95% CI, 70.39-129.63) vitamin D restored 25(OH)D to normal concentrations. Body composition data revealed inverse correlations between changes in serum 25(OH)D (from pre- to postsupplementation) and body fat ( r = −0.80; very large). Data concerning positive impacts of vitamin D supplementation on bone health and physical performance remain sparse. Conclusion: The high proportion of vitamin D inadequacy underscores the need to screen for serum 25(OH)D in basketball players. Although supplementation restored vitamin D sufficiency, the beneficial effects on bone health and physical performance remain sparse. Adiposity can modulate 25(OH)D response to supplementation.

scholarly journals Vitamin K and D Supplementation and Bone Health in Chronic Kidney Disease—Apart or Together?

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 809
Author(s):  
Marta Ziemińska ◽  
Beata Sieklucka ◽  
Krystyna Pawlak
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Vitamin K ◽  
Bone Health ◽  
Clinical Evidence ◽  
Mechanisms Of Action ◽  
Preclinical Studies ◽  
Normal Bone ◽  
Combined Supplementation

Vitamin K (VK) and vitamin D (VD) deficiency/insufficiency is a common feature of chronic kidney disease (CKD), leading to impaired bone quality and a higher risk of fractures. CKD patients, with disturbances in VK and VD metabolism, do not have sufficient levels of these vitamins for maintaining normal bone formation and mineralization. So far, there has been no consensus on what serum VK and VD levels can be considered sufficient in this particular population. Moreover, there are no clear guidelines how supplementation of these vitamins should be carried out in the course of CKD. Based on the existing results of preclinical studies and clinical evidence, this review intends to discuss the effect of VK and VD on bone remodeling in CKD. Although the mechanisms of action and the effects of these vitamins on bone are distinct, we try to find evidence for synergy between them in relation to bone metabolism, to answer the question of whether combined supplementation of VK and VD will be more beneficial for bone health in the CKD population than administering each of these vitamins separately.

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