Embedded Files
raloxifene. The overall treatment rates for each year were calculated, and a trended chi-square analysis was performed to evaluate whether the change in treatment over the four years of the study was significant (p < 0.05). Results n 1997, five patients were receiving antiosteoporotic medication at the time of admission. Three of these five patients were taking calcium, and none of the five had a change in treatment. In addition, three patients who were not taking medication received a prescription for medication (supplemental calcium) before discharge (Table I). Overall, only eight (11%) of the seventy-five patients were being treated for osteoporosis at the time of discharge. In 1998, three patients were receiving medication at the time of admission. One of these three patients was being treated with calcium, and none of the three had a change in treatment. In addition, seven patients who were not taking medication at the time of admission received a prescription for medication at the time of discharge; calcium was prescribed for six of these seven patients. Overall, ten (13%) of the seventy-five patients were being treated for osteoporosis at the time of discharge. In 1999, eleven patients were receiving medication at the time of admission. Seven of these eleven patients were receiving calcium, and none of the eleven had a change in treatment. Seven additional patients who were not receiving medication at the time of admission received a prescription for medication at the time of discharge; calcium was prescribed for all seven. Overall, eighteen (24%) of these seventy-five patients received some form of treatment for osteoporosis following the fragility fracture. In 2000, eleven patients who were receiving medication (including five patients who were receiving calcium) had no change in treatment and one patient had a change to a prescription drug. In addition, ten patients who were not receiving medication at the time of admission received a prescription for medication at the time of discharge; calcium was prescribed for eight of the ten. Overall, twenty-two (29%) of the seventy-five patients were being treated for osteoporosis at the time of discharge. Overall, for the years 1997 to 2000, the percentage of patients receiving some form of antiosteoporotic therapy at the time of discharge was 11%, 13%, 24%, and 29%, respectively. A trended chi-square test revealed that this increase was significant (p < 0.001), indicating that this improvement in the rate of treatment was unlikely to have occurred by chance alone (Fig. 1). The treatment patterns at all three hospitals were similar. Overall, fifty-eight (19.3%) of the 300 patients who had been diagnosed with a low-energy femoral neck fracture were discharged on some agent, either calcium or a prescription medication. Forty of these fifty-eight patients (13.3% of the overall group) were treated with calcium, leaving only eighteen patients (6.0% of the overall group) who received a prescription for an antiresorptive agent at the time of discharge. Discussion steoporosis often follows a prolonged asymptomatic course as bone mass gradually declines and the risk of I O Fig. 1 Graphical representation of the increase in treatment rates from 1997 to 2000 (p < 0.001). The bars for each year indicate the percentage of patients treated with calcium and the percentage of patients treated with a prescription antiresorptive medication. Downloaded from www.ejbjs.org on October 16, 2006 TH E JO U R NA L OF BONE & JOINT SURGER Y · JBJS.ORG VO LU M E 84-A · NUMB ER 8 · AU G U S T 2002 IM P ROVEM EN T I N THE UN DER T RE AT M EN T OF OSTEOPORO SIS FOL LOW ING HIP FR A C TU RE fracture increases. Often, the first clinical manifestation of osteoporosis is a fragility fracture of the hip, when the osteoporosis is already severe20. Following a sentinel fracture, appropriate diagnosis and treatment is critical. Pal21 administered a questionnaire to ninety-six patients who had sustained a low-energy fracture and found that most of the patients had received inadequate or incomplete advice regarding osteoporosis and that almost none of the patients had received antiosteoporotic medication. Abbasi et al.22, in a study of patients in a nursing home who had a history of hip fracture, found that 84% of the patients had no mention of osteopenia in their active medical problem list and therefore no intervention plan was in place to improve bone mass or prevent further bone loss. Freedman et al.19 evaluated patients with distal radial fractures and found little subsequent intervention or treatment for osteoporosis. In a similar study, Torgerson and Dolan23 found that, following an osteoporotic fracture, only patients with vertebral fractures received antiresorptive medication and that patients with hip fractures did not receive any medication. Postmenopausal women and elderly men who are hospitalized for an acute osteoporotic fracture are easy to target, yet these reports suggest that physicians neglect to treat such patients for osteoporosis even though low-energy fractures are a major risk factor for future fractures10-12,14,15,17. In the absence of treatment, a subsequent fragility fracture will occur in 10% of patients within one year and in 17% to 21% of patients within two years13-15 . In the present study, the percentage of patients with a hip fracture who were treated
Google Sites
Report abuse