Can Irisin Be Used in the Follow-up of Osteoporosis Treatment?

Interdisciplinary orthogeriatric care of older adult hip fracture patients is of growing importance due to an ageing population, yet there is ongoing disagreement about the most effective model of care. This study aimed to compare different forms of orthogeriatric treatment, with focus on their impact on postoperative mobilization, mobility and secondary fracture prevention. In this observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery, were included from 1 January 2016 to 31 December 2019. Data were recorded from hospital stay to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a specific designed registry for older adult hip fracture patients. Of 23,828 included patients from 95 different hospitals, 72% were female, median age was 85 (IQR 80–89) years. Increased involvement of geriatricians had a significant impact on mobilization on the first day (OR 1.1, CI 1.1–1.2) and mobility seven days after surgery (OR 1.1, CI 1.1–1.2), initiation of an osteoporosis treatment during in-hospital stay (OR 2.5, CI 2.4–2.7) and of an early complex geriatric rehabilitation treatment (OR 1.3, CI 1.2–1.4). These findings were persistent after 120 days of follow-up. Interdisciplinary treatment of orthogeriatric patients is beneficial and especially during in-patient stay increased involvement of geriatricians is decisive for early mobilization, mobility and initiation of osteoporosis treatment. Standardized treatment pathways in certified geriatric trauma departments with structured data collection in specific registries improve outcome monitoring and interpretation.

Download Full-text

Time-averaged disease activity of rheumatoid arthritis associated with long-term bone mineral density changes

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320981517 ◽

2020 ◽

Vol 11 ◽

pp. 204062232098151

Author(s):

Chung-Yuan Hsu ◽

Jia-Feng Chen ◽

Yu-Jih Su ◽

Ying-Chou Chen ◽

Han-Ming Lai ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Bone Mineral Density ◽

Bone Loss ◽

Disease Activity ◽

Bone Mineral ◽

Osteoporosis Treatment ◽

High Disease Activity ◽

Mineral Density

Background: Rheumatoid arthritis (RA) is associated with poor bone mineral density (BMD). We designed the current study owing to the lack of long-term prospective studies regarding whether a high disease activity leads to increased bone loss. Methods: We have continually enrolled patients with RA. According to the average disease activity score in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) during follow-up, the patients were classified into remission, low disease activity, and moderate or high disease activity groups. Patients were examined with dual-energy X-ray absorptiometry at baseline and after 3 years of follow-up. BMD changes were compared among the groups. Results: We have studied 477 patients. Overall BMD was significantly reduced from baseline to the 3-year follow-up ( p < 0.05). After stratifying according to the time-averaged DAS28-ESR levels and use of anti-osteoporosis treatment (AOT), the BMD values of the femur and spine significantly increased in patients in the remission group with AOT. The BMD changes of different DAS28-ESR patients were further compared using the generalized estimation equation model. For the patients on AOT, the negative change in femoral BMD values of the moderate or high activity group was significant when compared with the remission group with positive BMD changes (regression coefficient, –0.038; 95% confidence interval, –0.055 to –0.021). Conclusion: For RA patients, if remission is achieved, AOT can better improve BMD, especially in the femur. In addition, moderate or high disease activity will lead to significant bone loss; therefore, disease activity must be actively controlled.

Download Full-text

Early osteoporosis diagnosis improves post-hip fracture outcome

European Journal of Public Health ◽

10.1093/eurpub/ckz186.658 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

G Lavranos ◽

P P Manolopoulos ◽

P Xenophontos ◽

P Vogazianos ◽

K Tsioutis ◽

...

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Osteoporosis Treatment ◽

The Elderly ◽

University Hospital ◽

High Rate ◽

Osteoporosis Screening ◽

Fracture Outcome ◽

Overall Mortality

Abstract Background Hip fracture is associated with mortality and high rate of hospital re-admission after discharge. Osteoporosis screening and treatment have been shown to lower the risk of hip fractures. The aim of this study was to assess whether osteoporosis treatment also improves the post-hip fracture overall outcome. Methods All patients over the age of 65 that sustained a hip fracture at a tertiary University Hospital were approached to enroll in the study. The patients were informed of the context of the study, all queries were answered and an informed consent was signed by the patients in the presence of one of the investigators. The data were collected over an 8 month period from October 2017 to June 2018 and the cohort was followed up until February 2019. Recorded outcomes included mortality, re-admission and unscheduled hospital visit. Results The overall mortality rate of elderly patients after a hip fracture was 12.3% (n = 24) after a 6 month follow-up period. The overall event rate of elderly patients after a hip fracture was 29.7% (n = 58) after a 6 month follow-up period. Only 3% of patients were already on osteoporosis treatment. However, patients on treatment for osteoporosis had a favorable outcome with no deaths and significantly less overall events (p < 0.0001). Conclusions Early osteoporosis screening and treatment in the elderly can not only prevent falls and fractures, but also improve outcome in case a hip fracture does occur. Key messages Osteoporosis treatment improves outcome after a hip fracture. Despite relevant guidance, osteoporosis screening in the elderly remains suboptimal.

Download Full-text

Implementing nurse telephone follow-up clinics for monitoring parenteral osteoporosis treatment – a service evaluation

Clinical Medicine ◽

10.7861/clinmedicine.19-3-s59 ◽

2019 ◽

Vol 19 (Suppl 3) ◽

pp. 59-59

Author(s):

Sethu Mani-Babu ◽

Rita Abdulkader

Keyword(s):

Osteoporosis Treatment ◽

Service Evaluation

Download Full-text

Implementing nurse telephone follow-up clinics for monitoring parenteral osteoporosis treatment – a service evaluation

Clinical Medicine ◽

10.7861/clinmedicine.19-3s-s59 ◽

2019 ◽

Vol 19 (Suppl 3) ◽

pp. s59-s59

Author(s):

Sethu Mani-Babu ◽

Rita Abdulkader

Keyword(s):

Osteoporosis Treatment ◽

Service Evaluation

Download Full-text

67 How Well is Osteoporosis Checked for and Treated in Those Admitted with Fragility Fractures on General Medical Call?

Age and Ageing ◽

10.1093/ageing/afz103.36 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Muhammad Ridhwaan Salehmohamed ◽

Sarah O'Riordan ◽

Rachael Doyle ◽

Clodagh O'Dwyer

Keyword(s):

Vitamin D ◽

Hip Fractures ◽

Fragility Fractures ◽

Osteoporosis Treatment ◽

Vitamin D Supplementation ◽

Retrospective Audit ◽

History Of ◽

Recommended Guidelines ◽

Time Of Admission

Abstract Background Patients suffering a fragility fracture should be assessed and considered for treatment for osteoporosis according to current guidelines. This retrospective audit set out to assess if diagnosis and treatment of osteoporosis occurred appropriately in those admitted to a Model 2 Hospital with non-hip fractures on general medical call under all specialities. Methods All patients, admitted with fragility fractures, between January and June 2018, were included. Hip fracture patients treated through a separate ortho-geriatric rehab pathway were excluded. Data including source of admission, length of stay, type of fracture, investigations, treatments initiated or planned, were identified from patient’s records and collated using excel statistical analysis. Results From a total of 64 fracture admissions, 38 cases were non-Hip fractures. 34% (n=13) male, average age was 84 and 40% (n=15) patient had a history of previous fracture. Once admitted 68.4% (n=26), 60.5% (n=23) and 50.0% (n=19) had Vitamin D level, Bone profile and Serum Protein Electrophoresis checked respectively. Three patients passed away. 37% (n=13/35) of patients had a DXA scan performed either during or after their admission, all of whom were diagnostic for osteoporosis. 50% (n=19/38) were on Vitamin D at time of admission while 77% (n=27/35) were discharged on Vitamin D supplementation. 8% (n=3/38) were on osteoporosis treatment at time of admission while 31% (n=11/35) were discharged on, or had a plan in place for, osteoporosis treatment. Conclusion Investigation for and management of osteoporosis in patients admitted with fragility fractures are not being adhered to as per recommended guidelines. A new pathway under the supervision of a newly appointed c/RANP is being developed, in line with osteoporosis guidelines as a result, with a view to re audit and better follow-up of these patients.

Download Full-text

Telecarers in the Co-ordination of Secondary Osteoporosis Prevention in Hip Fracture Patients (Preprint)

10.2196/preprints.16397 ◽

2019 ◽

Author(s):

Linsey Gani ◽

Francine Tan ◽

Thomas Frederick King

Keyword(s):

Primary Care ◽

Hip Fracture ◽

Hip Fractures ◽

Osteoporosis Treatment ◽

Osteoporosis Prevention ◽

Osteoporosis Medication ◽

Post Discharge ◽

Significant Treatment ◽

Secondary Fracture

BACKGROUND There remains a significant treatment gap in osteoporosis patients. Our previous audit found that among all fragility fracture patients, rates of anti-osteoporosis medication initiation were between 10.1 to 31.5% at 1 year. OBJECTIVE To reduce over-utilization of hospital visits, we piloted the use of telecarers to follow up patients at specific time intervals post-discharge from hip fracture to monitor osteoporosis treatment and compliance. METHODS From January 2017 – January 2018, all hip fracture patients at Changi General Hospital, Singapore were automatically enrolled into the Health Management Unit (HMU) valued care hip fracture program. Upon discharge, telecarers from the HMU follow up patients to remind of attendance at clinic appointments and confirm compliance to anti-osteoporosis medication. Telecarer calls were scheduled at discharge, 3, 6 and 12 months. We assessed the acceptability, completion and treatment rates of patients enrolled in this program RESULTS 537 patients with hip fracture were enrolled in the telecarer program over 1 year. 341 patients completed 12 months follow up, of which 251 patients (73.6%) were on treatment at 12 months. The most common cause of treatment rejection is patient or family rejection (34.4%), this was followed by 24.4% of physician failure to prescribe and renal impairment in 24.4%, 16.7% of patients were deemed to have advanced dementia with life limiting illness and were thus thought not suitable for treatment. CONCLUSIONS Telecarer may be a useful adjunct in the monitoring of osteoporosis treatment post hip fractures. However the main limitations of treatment remain with patient and primary care clinician education which remains a challenge. Further studies should look into a combination of telecarer intervention for both patients and primary care clinicians to increase awareness of secondary fracture prevention. Given the significant mortality and morbidity post hip fractures, future efforts should also be aimed at primary prevention of hip fractures.

Download Full-text