scholarly journals Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients—An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU)

2021 ◽  
Vol 10 (23) ◽  
pp. 5489
Author(s):  
Johannes Gleich ◽  
Evi Fleischhacker ◽  
Katherine Rascher ◽  
Thomas Friess ◽  
Christian Kammerlander ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older Adult ◽  
Osteoporosis Treatment ◽  
Fracture Prevention ◽  
Observational Cohort Study ◽  
Geriatric Trauma ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Observational Cohort

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.

scholarly journals OR13-06 Implementation of a High-Risk Fracture Program in an Integrated Healthcare Delivery System

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kendal L Hamann ◽  
Malini Chandra ◽  
Rita L Hui ◽  
Catherine Lee ◽  
Mehreen M Khan ◽  
...  
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Osteoporotic Fracture ◽  
Treatment Initiation ◽  
Osteoporosis Treatment ◽  
Fracture Prevention ◽  
Wrist Fracture ◽  
Osteoporosis Therapy ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention

Abstract BACKGROUND: Fracture events in older adults are important opportunities for secondary prevention. In response to national (HEDIS) quality metrics in 2008, our medical group implemented a fracture prevention program, identifying women age ≥65y who experienced a fracture and targeting them for osteoporosis screening or treatment within six months. In 2015, we added an outreach program for “high-risk secondary fracture prevention” targeting women age 60-85y and men age 70-85y for osteoporosis therapy within 6 months after a hip, pelvic, humerus, wrist or vertebral fracture. This study examines whether targeting “high-risk fracture” in women and men results in higher treatment rates following a non-vertebral major osteoporotic fracture. METHODS: This retrospective study was conducted using data from women age 60-85y and men age 70-85y who experienced a fracture of the hip, humerus, and wrist in 2013-2014 (Cohort 1, the era of our HEDIS-only program) or 2015-2016 (Cohort 2, the era of our added “high-risk secondary fracture prevention” program). We excluded patients with primary bone disorders or metastatic cancer and those with osteoporosis treatment in the year prior to fracture. Osteoporosis drug therapy (oral/IV bisphosphonates, denosumab, raloxifene or teriparatide) initiated within six months after the fracture date was assessed. Differences between groups were compared using the chi-squared test, and multivariable logistic regression was used to examine predictors of treatment. RESULTS: There were 5727 (Cohort 1) and 6469 (Cohort 2) adults identified with hip, humerus, or wrist fracture (high risk fracture). Wrist fracture was the most prevalent fracture in women and hip fracture the most prevalent in men. Osteoporosis treatment initiation within 6 months of the fracture date was achieved for 38% of women and 13% of men in Cohort 1 and 37% of women and 25% of men in Cohort 2. Among women age 60-64, treatment increased from 14% (Cohort 1) to 25% (Cohort 2). Overall, fracture in the later era (2015-2016) was associated with a slightly lower odds of post fracture treatment initiation (adjusted odds ratio OR 0.8, 95% confidence interval (CI) 0.7-0.9) in women 65-85y; however, a much higher odds of treatment was seen (OR 2.3, 95% CI 1.9-2.9) for men 70-85y. Older age, hip fracture, and past osteoporosis therapy were also associated with greater odds of treatment within 6 months. CONCLUSION: Targeted high-risk fracture intervention resulted in a 2-fold increase in osteoporosis treatment after major non-vertebral osteoporotic fracture in men 70-85y and women 60-64y, the demographic subgroups not previously targeted by HEDIS-based intervention. However, treatment of fractures in women already targeted by HEDIS-based intervention did not increase. Future studies should address potential barriers to treatment and assess the impact of added high-risk fracture outreach on adherence to therapy.

scholarly journals Early benefits of a secondary fracture prevention programme

2021 ◽  
pp. 112070002110274
Author(s):  
Gershon Zinger ◽  
Noa Sylvetsky ◽  
Yedin Levy ◽  
Kobi Steinberg ◽  
Alexander Bregman ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Intervention Group ◽  
Fracture Prevention ◽  
Intervention Programme ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Randomised Study ◽  
Dexa Scan

Introduction: The most successful programme for secondary fracture prevention is the FLS (fracture liaison service) model. Our orthopaedic department carried out a prospective randomised study to measure the effectiveness of a 4-step intervention programme. The findings in this study reveal important additional clinical benefits to having an orthopaedic-based FLS programme and evaluates the usefulness of fracture risk tools. Methods: We carried out a prospective study to evaluate patients with a fragility fracture of the hip. There were 2 groups, intervention and control (each 100 patients). Of these, 20 were either removed from the study or dropped out, leaving 180 for analysis. In addition to routine preoperative blood tests, albumin and thyroid function levels were obtained and PTH (parathyroid hormone) levels when indicated. The intervention group (83 patients) had a dual-energy x-ray absorptiometry (DEXA) scan performed and fracture risk (FRAX) was calculated. Results: 12 patients (6.7%) had blood results which showed a potentially treatable cause for osteoporosis and 36 (20%) had blood results that changed their medical care. FRAX scores (180 patients) showed that the major osteoporotic fracture score correctly predicted the hip fracture in only 49%. The hip fracture score correctly predicted the hip fracture in 83%. DEXA scores (65 patients) showed osteoporosis in only 46% of hips and in only 26% of spines. An abnormal FRAX score or DEXA scan would have predicted a fragility fracture 93% of the time. Conclusions: In addition to reducing secondary fractures, FLS programmes can provide fundamental benefits to the health of the patient. The intervention programme in this study identified patients with underlying treatable causes, correctable clinical conditions and patients with an unusually low bone density. When used together, FRAX and DEXA are more sensitive predictors for hip fracture risk than either are individually. Trial registry: 201497CTIL ( https://clinicaltrials.gov/ct2/show/NCT02239523 )

scholarly journals Geographic variation in secondary fracture prevention after a hip fracture during 1999–2013: a UK study

2016 ◽  
Vol 28 (1) ◽  
pp. 169-178 ◽  
Author(s):  
A. Shah ◽  
◽  
D. Prieto-Alhambra ◽  
S. Hawley ◽  
A. Delmestri ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Geographic Variation ◽  
Fracture Prevention ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention

Secondary fracture prevention in hip fracture patients requires cooperation from general practitioners

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Jan Vaculík ◽  
Jan J. Stepan ◽  
Pavel Dungl ◽  
Marek Majerníček ◽  
Alexander Čelko ◽  
...  
Keyword(s):  
Hip Fracture ◽  
General Practitioners ◽  
Fracture Prevention ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention

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

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.

scholarly journals Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England

2016 ◽  
Vol 4 (28) ◽  
pp. 1-170 ◽  
Author(s):  
Andrew Judge ◽  
M Kassim Javaid ◽  
José Leal ◽  
Samuel Hawley ◽  
Sarah Drew ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hip Fracture ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Fracture Prevention ◽  
Service Evaluation ◽  
Models Of Care ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Prevention Services

BackgroundProfessional bodies have produced comprehensive guidance about the management of hip fracture. They recommend orthogeriatric services focusing on achieving optimal recovery, and fracture liaison services (FLSs) focusing on secondary fracture prevention. Despite such guidelines being in place, there is significant variation in how services are structured and organised between hospitals.ObjectivesTo establish the clinical effectiveness and cost-effectiveness of changes to the delivery of secondary fracture prevention services, and to identify barriers and facilitators to changes.DesignA service evaluation to identify each hospital’s current models of care and changes in service delivery. A qualitative study to identify barriers and facilitators to change. Health economics analysis to establish NHS costs and cost-effectiveness. A natural experimental study to determine clinical effectiveness of changes to a hospital’s model of care.SettingEleven acute hospitals in a region of England.ParticipantsQualitative study – 43 health professionals working in fracture prevention services in secondary care.InterventionsChanges made to secondary fracture prevention services at each hospital between 2003 and 2012.Main outcome measuresThe primary outcome is secondary hip fracture. Secondary outcomes include mortality, non-hip fragility fracture and the overall rate of hip fracture.Data sourcesClinical effectiveness/cost-effectiveness analyses – primary hip fracture patients identified from (1) Hospital Episode Statistics (2003–13,n = 33,152); and (2) Clinical Practice Research Datalink (1999–2013,n = 11,243).ResultsService evaluation – there was significant variation in the organisation of secondary fracture prevention services, including staffing levels, type of service model (consultant vs. nurse led) and underlying processes. Qualitative – fracture prevention co-ordinators gave multidisciplinary health professionals capacity to work together, but communication with general practitioners was challenging. The intervention was easily integrated into practice but some participants felt that implementation was undermined by under-resourced services. Making business cases for a service was particularly challenging. Natural experiment – the impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) 0.73 [95% confidence interval (CI) 0.65 to 0.82] and HR 0.81 (95% CI 0.75 to 0.87), respectively. Thirty-day and 1-year mortality were likewise reduced following the introduction or expansion of a FLS: HR 0.80 (95% CI 0.71 to 0.91) and HR 0.84 (95% CI 0.77 to 0.93), respectively. There was no significant impact on time to secondary hip fracture. Health economics – the annual cost in the year of hip fracture was estimated at £10,964 (95% CI £10,767 to £11,161) higher than the previous year. The annual cost associated with all incident hip fractures in the UK among those aged ≥ 50 years (n = 79,243) was estimated at £1215M. At a £30,000 per quality-adjusted life-year threshold, the most cost-effective model was introducing an orthogeriatrician.ConclusionIn hip fracture patients, orthogeriatrician and nurse-led FLS models are associated with reductions in mortality rates and are cost-effective, the orthogeriatrician model being the most cost-effective. There was no evidence for a reduction in second hip fracture. Qualitative data suggest that weaknesses lie in treatment adherence/monitoring, a possible reason for the lack of effectiveness on second hip fracture outcome. The effectiveness on non-hip fracture outcomes remains unanswered.Future workReliable estimates of health state utility values for patients with hip and non-hip fractures are required to reduce uncertainty in health economic models. A clinical trial is needed to assess the clinical effectiveness and cost-effectiveness of a FLS for non-hip fracture patients.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme and the NIHR Musculoskeletal Biomedical Research Unit, University of Oxford.

Prescribing and adherence to bone protection medications following hip fracture in the United Kingdom

2019 ◽  
Vol 101-B (11) ◽  
pp. 1402-1407 ◽  
Author(s):  
Matthew Cehic ◽  
Robin G. Lerner ◽  
Juul Achten ◽  
Xavier L. Griffin ◽  
Daniel Prieto-Alhambra ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Health Assessment ◽  
Fracture Prevention ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Adherence To Medication ◽  
The United Kingdom ◽  
Hip Trauma ◽  
Bone Protection ◽  
Discharge Summaries

Aims Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group. Patients and Methods The World Hip Trauma Evaluation (WHiTE) is a multicentre, prospective cohort of hip fracture patients in NHS hospitals in England and Wales. Patients aged 60 years and older who received operative treatment for a hip fracture were eligible for inclusion in WHiTE. The prescription of bone protection medications was recorded from participants’ discharge summaries, and participant-reported use of bone protection medications was recorded at 120 days following surgery. Results Of 5456 recruited patients with baseline data, 2853 patients (52%) were prescribed bone protection medication at discharge, of which oral bisphosphonates were the most common, 4109 patients (75%) were prescribed vitamin D or calcium, and 606 patients (11%) were not prescribed anything. Of those prescribed a bone protection medication, only 932 patients (33%) reported still taking their medication 120 days later. Conclusion These data provide a reference for current prescription and adherence rates. Adherence with oral medication remains poor in patients with hip fracture. Cite this article: Bone Joint J 2019;101-B:1402–1407.

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