63 Impact of an Orthogeriatric Service on Osteoporosis Management in HIP Fracture Patients

Abstract Background Osteoporosis which is now treatable is the major risk factor for hip fractures in the elderly. Having a hip fracture increases morbidity and mortality. Hip fractures are costly. Incidence increases with age. Aims To examine how introduction of an orthogeriatric service (OGS) improves osteoporosis management. Method A dedicated OGS was established in the orthopaedic unit in an Australian tertiary teaching hospital in July 2014. Retrospective analyses were undertaken to compare osteoporosis diagnosis and treatment rates in patients ≥ 65 years old presenting with minimal trauma hip fractures (MTHF) before and after the OGS was established. Results 1. 108 MTHF (mean age 81 years) and 107 MTHF (mean age 82 years) were admitted in 2014 respectively before and after the OGS was established. 2. New osteoporosis diagnoses increased by 27%, new calcium &/or vitamin D prescription increased by 17% and new antiresorptive treatment increased by 30%, after the OGS was established. 3. The odds ratio for receiving a new diagnosis of osteoporosis post MTHF with the OGS compared to pre-OGS was 4.4 (2.1 – 9.0), p<0.0001. 4. The odds ratio for initiating new antiresorptive treatment post fractured NOF with OGS compared to pre-OGS was 6.2 (3.0 – 12.7), p<0.0001. 5. Rates of new diagnoses of osteoporosis and initiation of antiresorptive treatments with the OGS were not affected by age or gender. Conclusion 1. Introduction of a dedicated OGS improved osteoporosis diagnoses and initiation of antiresorptive treatments. 2. Patients who received a new diagnosis of osteoporosis and/or started on antiresorptive treatment were also likely to be prescribed calcium and/or vitamin D supplements as well. 3. There did not appear to be any age or gender bias towards giving more new diagnoses of osteoporosis and/or more new antiresorptive treatments with a dedicated OGS. 4. These results may be useful for benchmarking and comparison purposes.

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Hyponatraemia in Hip Fracture Patients

Scottish Medical Journal ◽

10.1177/003693300204700506 ◽

2002 ◽

Vol 47 (5) ◽

pp. 115-116 ◽

Cited By ~ 13

Author(s):

E. McPherson ◽

R. A. Dunsmuir

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Retrospective Review ◽

Surgical Intervention ◽

Close Monitoring ◽

Neck Of Femur ◽

Before And After

We performed a retrospective review of hyponatraemia in patients with hip fractures, before and after surgery. All patients admitted with fractures of the neck of femur who had a surgical intervention to deal with the fracture were included. Results were determined using two definitions for hyponatraemia. The incidence of preoperative and post-operative hyponatraemia were both 2.8% if hyponatraemia was defined as [Na]<130mmol/l. No cases of hyponatraemia were found pre-operatively when hyponatraemia was defined as [Na]<125mmol/l. Using this definition the post operative incidence of hyponatraemia was 0.93%. The incidence of hyponatraemia in this group of patients is small. However the potentially severe affects of hyponatraemia warrant close monitoring of these patients and the establishment of methods to prevent this problem from occurring.

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141 Fall-Risk Increasing Drugs use in Elderly with Fall-Related Fractures

Age and Ageing ◽

10.1093/ageing/afz164.141 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv34-iv39

Author(s):

Chin Yeong Low ◽

Marhanis Salihah Omar ◽

Hazlina Mahadzir ◽

Mei Kuen Yin

Keyword(s):

Hip Fractures ◽

Fall Risk ◽

The Elderly ◽

High Morbidity ◽

Tertiary Teaching ◽

Before And After ◽

Icd 10 ◽

Tertiary Teaching Hospital ◽

Extrinsic Risk ◽

Risk Factors For Falls

Abstract Introduction Elderly populations are at the highest risk of fatal falls and fracture is one of the fall-related injuries which results in high morbidity and mortality. A group of drugs have been identified as the fall risk increasing drugs (FRIDs) and listed as one of the modifiable extrinsic risk factors for falls. This study aimed to determine the use of FRIDs in fall-related fractures among elderly patients. Method Patients aged 65 years and above admitted to a tertiary teaching hospital due to falls were included. Falls were identified through a case-mix system using the ICD-10 codes of W01 and W18 (fall at the same level). Patient medical records were reviewed retrospectively and drugs use before the falls were analysed. Results Among the patients included (n=124), majority of them had fall-related fractures (83.1%) and hip fractures were among the highest type of fractures (67%). The older old (≥ 80 years) had recorded a significant higher incidence of hip fractures compared to the younger individuals (p=0.009). About 75% of the patients with fall-related fractures had recorded use of at least one FRID before the admission. The younger individuals had significantly higher use of FRIDs compared to the older old, particularly the anti-hypertensive drugs (p=0.017). Most of them (>80%) still received FRIDs at discharge and deprescribing was commenced in less than one quarter of the patients. Furthermore, 32.6% of them had either an addition of new FRIDs or increased of the FRIDs dose at discharge. Conclusion In conclusion, fracture was the major reason of admissions among the elderly with falls. The older old recorded higher incidence of fall-related hip fractures. There was high usage of FRIDs before and after fall-related fractures. Deprescribing was not widely practiced in the elderly after the fall incidence.

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Vitamin D supply of patients with hip fracture

Orvosi Hetilap ◽

10.1556/oh.2014.29878 ◽

2014 ◽

Vol 155 (17) ◽

pp. 659-668 ◽

Cited By ~ 1

Author(s):

Antal Salamon ◽

Balázs Hepp ◽

Ákos Mátrai ◽

Csaba Biró ◽

Katalin Ágota ◽

...

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Vitamin D Deficiency ◽

Hip Fractures ◽

Hydroxyvitamin D ◽

Control Subjects ◽

25 Hydroxyvitamin D ◽

Few Data ◽

Prevention And Cure ◽

The Relationship

Introduction: Vitamin D deficiency is an important risk factor for fractures. However, there are few data available only on the relationship between serum 25-hydroxyvitamin D levels and recovery after surgery for hip fracture. Aim: The authors investigate the vitamin D supply of patients with hip fractures. Method: Between February and September 2013, serum 25-hydroxyvitamin D and parathyroid hormone levels were determined in 203 patients with hip fracture (74.8±11.5 ys; 67 men and 136 women) and in 74 control subjects. Results: Vitamin D deficiency and secondary hyperparathyroidism occurred significantly more frequently in patients with hip fracture than in control subjects (72% vs. 45%, and 33% vs. 17%, respectively). Patients with better condition after surgery showed higher 25-hydroxyvitamin D levels (p<0.001) than those with poor condition. Serum 25-hydroxyvitamin D were lower in the 31 patients who died [median of survival time: 19 (5–52) days] compared to those who survived [22.6 (9.5–45.0) vs. 33.0 (16.5–56.6) nmol/l]. Conclusions: The association between vitamin-D deficiency and mortality as well as the positive correlation between serum 25-hydroxyvitamin D levels and better postoperative condition confirm the importance of proper vitamin D supply in the prevention and cure of hip fractures, what is more in the increase of the chance of survival. Orv. Hetil., 2014, 155(17), 659–668.

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A Hospitalist-Led Fracture Liaison Service Improves Care of Hip Fracture Patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.490 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A241-A241

Author(s):

Anne Drabkin ◽

Micol Sara Rothman ◽

Goold Audrey ◽

Yasui Robin ◽

Mancini Diana

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Primary Care Providers ◽

The United States ◽

Fracture Liaison Service ◽

Care Providers ◽

Osteoporosis Care ◽

Fracture Liaison

Abstract Background: Osteoporosis care traditionally falls to outpatient primary care providers despite the fact that over 300,000 elderly patients are hospitalized yearly with hip fractures in the United States. Internal medicine hospitalists are often involved in the co-management of their care on surgical teams and are skillful in osteoporosis recognition and management. Objective: A hospitalist-led Fracture Liaison Service (FLS) was established to provide improved care of hospitalized patients with hip fractures. Methods: A retrospective evaluation of inpatient and post-discharge management of patients admitted with low-impact hip fractures was performed before (8/17-2/18) and after (8/19 - 2/20) launch of the hospitalist Fracture Liaison Service (H-FLS). Results: Eighty-nine patients were admitted with a hip fracture in post-launch period compared to 73 admitted prior. 74% vs 11% of eligible patients (based on adequate renal function and vitamin D stores) were discharged with anti-osteoporosis medications (p<0.001), 82% vs 38% were discharged with vitamin D/calcium supplements (p<0.001), 22% vs 5% underwent a DXA scan after discharge (p<0.05) and 65% vs 0% were referred to outpatient osteoporosis-specific care at discharge (p<0.001). Conclusion: A hospitalist-led FLS is a unique approach to osteoporosis care that significantly improved quality metrics for elderly patients with osteoporotic hip fractures including initiation of anti-osteoporosis medication and bone density imaging. Outpatient follow-up data are needed to evaluate adherence to this initial management over time.

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67 Reducing Delays to Operative Management of Anti-Coagulated Patients With Hip Fractures

Age and Ageing ◽

10.1093/ageing/afz187.08 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i18-i20

Author(s):

J Ensanullah ◽

B Shah ◽

M Fertleman

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Heart Valves ◽

Guideline Implementation ◽

Operative Management ◽

National Guidelines ◽

Improvement Project ◽

Before And After ◽

Surgery Timing ◽

The Uk

Abstract Introduction In the UK, the gold-standard treatment of a hip fracture is surgical fixation within 36 hours. Reduced delay to surgery has been shown to minimise the risk of complications. Locally, frequent delays to surgery were observed in patients taking long-term anticoagulation. There are no national guidelines regarding anticoagulation reversal and surgery timing in patients with hip fractures, and doctors are often unfamiliar with increasingly prevalent Direct Oral Anti-coagulants (DOACs). This quality improvement project aimed to reduce delays to surgery in anti-coagulated patients with hip fractures. Methods A guideline was formulated following literature review and consultation with a Consultant Ortho-geriatrician, Orthopaedic Surgeon and Haematologist. Retrospective casenote audit was conducted including 3-month period before and after implementation. The new guideline was disseminated in poster form. Due to the observation that delays in receiving INR results resulted in reversal delay, patient’s on warfarin were recommended to receive 5 mg IV Vitamin K prior to receiving INR results. The INR was rechecked after 6 hours, and if less than 1.6, surgery could proceed. Those on DOACs could undergo surgery 24 hours after the last dose providing eGFR >30, and after 48 hours if eGFR <30. Exclusions were those anti-coagulated for metallic heart valves or recent venous thromboembolism. Results In the 3 months prior to guideline implementation, 71 patients had a hip fracture; 15 were anti-coagulated. Of these, 8 patients were delayed due to their anticoagulation. Repeat audit after implementation, included 46 patients with a hip fracture over the 3-month period; 7 were anti-coagulated. None were delayed due to anticoagulation (p < 0.05). Conclusions This improvement project describes formulation of a simple protocol with evidence from the literature and local expert opinion in order to reduce unnecessary delays in anti-coagulated patients with hip fractures.

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SO072INCIDENCE OF FRACTURES BEFORE AND AFTER DIALYSIS INITIATION AMONG INCIDENT DIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa139.so072 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Ken Iseri ◽

Juan Jesus Carrero ◽

Marie Evans ◽

Li Felländer-Tsai ◽

Hans Berg ◽

...

Keyword(s):

Hip Fracture ◽

Incidence Rate ◽

Hip Fractures ◽

Temporal Pattern ◽

Incidence Rates ◽

Fracture Incidence ◽

Dialysis Initiation ◽

Dialysis Patients ◽

Initiation Of Dialysis ◽

Before And After

Abstract Background and Aims The incidence of fractures is markedly higher in dialysis patients than in pre-dialysis patients, but it is not clear to what extent the initiation of dialysis as such is associated with accelerated fracture incidence or if fracture rates are already increasing prior to dialysis start among incident dialysis patients. Here we investigated the temporal pattern of occurrence of a first major osteoporotic fracture (MOF) among incident dialysis patients in the pre-dialysis period and in the period following dialysis initiation. Method We analyzed data from Swedish Renal Registry (SRR) and identified 9041 incident dialysis patients (2005 -2015; age 67 years, 67% men). We identified all first MOF (MOFfirst) in hip, spine, humerus and forearm during 12 months before and after dialysis initiation. Using flexible parametric hazard models and Fine-Gray analysis accounting for competing risk of death and renal transplantation, we estimated adjusted fracture incidence rates and predictors of MOFfirst. Results During the whole follow-up period, there were 361 fractures including 196 hip fractures. The crude incidence rate of MOFfirst (n=157) before dialysis initiation was 17/1000 patient-years and after initiation of dialysis the incidence rate of MOFfirst increased to 24/1000 patient-years. Overall the adjusted MOFfirst incidence rates increased from 6 months before initiation of dialysis, fluctuated, and stabilized at a higher rate than that of the baseline rate after 12 months. The adjusted hip fracture rate rose steeply 3 months before dialysis initiation, declined 3 months after dialysis initiation, fluctuated, and then became stabilized. On the contrary, the adjusted incidence rates of other fractures, i.e., non-hip fractures, appeared to be stable all the time, before as well as after initiation of dialysis. Female gender, higher age and previous history of MOF had a negative impact on fracture incidence rates before and after dialysis initiation. Conclusion We conclude that the incidence of MOFfirst is increasing already from 6 months prior to dialysis initiation among incident dialysis patients, and that there is a further increase following dialysis initiation. For hip fracture, which was the most common MOF, the temporal pattern of incidence rates was compressed to a high risk period lasting from 3 months before to 3 months after dialysis initiation, underlining the need of increased attention to prevent hip fractures in incident dialysis patients during this critical period.

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Before and after hip fracture, vitamin D deficiency may not be treated sufficiently

Osteoporosis International ◽

10.1007/s00198-013-2400-z ◽

2013 ◽

Vol 24 (11) ◽

pp. 2765-2773 ◽

Cited By ~ 17

Author(s):

S. Maier ◽

E. Sidelnikov ◽

B. Dawson-Hughes ◽

A. Egli ◽

R. Theiler ◽

...

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Vitamin D Deficiency ◽

Before And After

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O02 Is vitamin D testing essential in elderly patients with a hip fracture?

Rheumatology ◽

10.1093/rheumatology/keaa110.001 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Serena N Mehta ◽

Mohd K Omar ◽

Hem Sapkota

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Osteoporosis Treatment ◽

Vitamin D Supplementation ◽

High Dose ◽

Medication History ◽

Vitamin D Levels ◽

High Dose Vitamin

Abstract Background Elderly patients with hip fractures are likely to be vitamin D deficient. As per some studies, a vitamin D level above 75nmol/L is considered to be sufficient for this cohort. The majority of these patients will require treatment for their osteoporosis. Prior to treatment, vitamin D levels need to be sufficient, however there is often a delay to obtain vitamin D test results and this can postpone the initiation of osteoporosis management. In this retrospective study, we hypothesised whether empirical, high dose vitamin D treatment can be given to patients with hip fractures, regardless of their vitamin D level, who are not currently on vitamin D supplementation. Methods We obtained a list of 917 patients with a hip fracture, aged over 50, from the Trust National Hip Fracture Database from January 2017 to December 2018. We accessed patients’ electronic hospital and GP records to collect patient demographics, vitamin D levels, and medication history. Results The mean age in this study was 82.7 years, and 69.8% were female. Vitamin D levels were available for 666 patients. Of this, 69.9% of patients had a below adequate level (50 nmol/L) and 88.4% of patients had a below sufficient level (75 nmol/L) of vitamin D. Electronic records for vitamin D supplementation were only available for 434 patients. Of this, 300 patients (69.1%) were not on any form of vitamin D supplementation. In this cohort, only 7 patients had a vitamin D level above sufficient levels (75 nmol/L). Upon contacting these 7 patients; 3 were taking some form of vitamin D supplementation, 3 died and no information was available for 1. Conclusion Our study demonstrates all patients with a hip fracture, who are not taking any form of vitamin D supplementation will have subtherapeutic vitamin D levels. Thus, patients presenting with a hip fracture, can be treated empirically with high dose vitamin D treatment, without prior vitamin D testing. This would reduce the number of vitamin D tests conducted by 69.1% which will enable patients to receive prompt osteoporosis treatment and will reduce costs. Disclosures S.N. Mehta None. M.K. Omar None. H. Sapkota None.

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Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA

BMC Geriatrics ◽

10.1186/s12877-020-01924-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rafia S. Rasu ◽

Rana Zalmai ◽

Aliza R. Karpes Matusevich ◽

Suzanne L. Hunt ◽

Milind A. Phadnis ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Treatment Plan ◽

Hospital Length Of Stay ◽

Hospital Charges ◽

Hospital Outcomes ◽

Diagnosis Of Osteoporosis ◽

Dementia Patients ◽

The Usa ◽

White Patients

Abstract Background About 50% of all hospitalized fragility fracture cases in older Americans are hip fractures. Approximately 3/4 of fracture-related costs in the USA are attributable to hip fractures, and these are mostly covered by Medicare. Hip fracture patients with dementia, including Alzheimer’s disease, have worse health outcomes including longer hospital length of stay (LOS) and charges. LOS and hospital charges for dementia patients are usually higher than for those without dementia. Research describing LOS and acute care charges for hip fractures has mostly focused on these outcomes in trauma patients without a known pre-admission diagnosis of osteoporosis (OP). Lack of documented diagnosis put patients at risk of not having an appropriate treatment plan for OP. Whether having a diagnosis of OP would have an effect on hospital outcomes in dementia patients has not been explored. We aim to investigate whether having a diagnosis of OP, dementia, or both has an effect on LOS and hospital charges. In addition, we also report prevalence of common comorbidities in the study population and their effects on hospital outcomes. Methods We conducted a cross-sectional analysis of claims data (2012–2013) for 2175 Medicare beneficiaries (≥65 years) in the USA. Results Compared to those without OP or dementia, patients with demenia only had a shorter LOS (by 5%; P = .04). Median LOS was 6 days (interquartile range [IQR]: 5–7), and the median hospital charges were $45,100 (IQR: 31,500 − 65,600). In general, White patients had a shorter LOS (by 7%), and those with CHF and ischemic heart disease (IHD) had longer LOS (by 7 and 4%, respectively). Hospital charges were 6% lower for women, and 16% lower for White patients. Conclusion This is the first study evaluating LOS in dementia in the context of hip fracture which also disagrees with previous reporting about longer LOS in dementia patients. Patients with CHF and IHD remains at high risk for longer LOS regardless of their diagnosis of dementia or OP.

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Hospitalisations for falls and hip fractures attributable to vitamin D deficiency in older Australians

British Journal Of Nutrition ◽

10.1017/s0007114521000416 ◽

2021 ◽

pp. 1-13

Author(s):

Rachel E Neale ◽

Louise F Wilson ◽

Lucinda J Black ◽

Mary Waterhouse ◽

Robyn M Lucas ◽

...

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Vitamin D Deficiency ◽

Hip Fractures ◽

Sun Exposure ◽

Australian Health ◽

Relative Risks ◽

Increased Risk ◽

Risk Of Falls ◽

The Impact

ABSTRACT Vitamin D deficiency is associated with increased risk of falls and fractures. Assuming this association is causal, we aimed to identify the number and proportion of hospitalisations for falls and hip fractures attributable to vitamin D deficiency [25 hydroxy D (25(OH)D) <50 nmol/L] in Australians aged 65 years and over. We used 25(OH)D data from the 2011/12 Australian Health Survey and relative risks from published meta-analyses to calculate population attributable fractions for falls and hip fracture. We applied these to data published by the Australian Institute of Health and Welfare to calculate the number of events each year attributable to vitamin D deficiency. In men and women combined, 8.3% of hospitalisations for falls (7991 events) and almost 8% of hospitalisations for hip fractures (1315 events) were attributable to vitamin D deficiency. These findings suggest that even in a sunny country such as Australia vitamin D deficiency contributes to a considerable number of hospitalisations as a consequence of falls and for treatment of hip fracture in older Australians; in countries where the prevalence of vitamin D deficiency is higher the impact will be even greater. It is important to mitigate vitamin D deficiency but whether this should occur through supplementation or increased sun exposure needs consideration of the benefits, harms, practicalities, and costs of both approaches.

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