Background: Treatment of osteoporosis following a hip fracture has
been notoriously poor. Many efforts have been made to improve treatment rates.
The purpose of this study was to determine whether a perioperative inpatient
intervention program, involving patient education and providing a list of
questions for the primary care physician, increased the percentage of patients
in whom osteoporosis was addressed following a hip fracture.
Methods: A prospective, randomized trial involving eighty patients
who had been admitted to an academic medical center with a low-energy hip
fracture was conducted. During their hospitalization, the study group patients
were engaged in a fifteen-minute discussion regarding the association between
osteoporosis and hip fractures, the efficacy of dual-energy x-ray
absorptiometry scans in the diagnosis of osteoporosis and of bisphosphonates
in its treatment, and the importance of medical follow-up for osteoporosis
management. These patients were also provided with five questions regarding
osteoporosis treatment to be given to their primary medical physician, and
they were reminded about the questions during a follow-up telephone call six
weeks later. The patients in the control group received a brochure describing
methods for preventing falls. Both groups were contacted by telephone at six
months after discharge to determine whether osteoporosis had been addressed.
Positive indicators of intervention included assessment of bone mineral
density with dual-energy x-ray absorptiometry and initiation of antiresorptive
Results: The average age in each group was eighty-two years, and 78%
of the patients were female. Four patients in each group did not survive
through the six-month follow-up period and were excluded from the trial.
Fifteen (42%) of the thirty-six patients who had been randomized to the study
group, compared with only seven (19%) of the thirty-six patients in the
control group, had their osteoporosis addressed by their primary physician.
This difference between the groups was significant (p = 0.036).
Conclusions: Patients who were provided with information and
questions for their primary care physician about osteoporosis were more likely
to receive appropriate therapeutic intervention than were patients who had not
received the information and questions. Orthopaedic surgeons have a unique
opportunity to improve the rate of osteoporosis treatment in the perioperative
period following a hip fracture by educating patients and directing them
toward channels for long-term osteoporosis management.
Level of Evidence: Therapeutic study, Level I. See
Instructions to Authors for a complete description of levels of evidence.