Background: Osteoporosis has been described as a "silent
epidemic." We describe an osteoporosis consultation program to
facilitate the evaluation and treatment of inpatients with fragility
Methods: The inpatient orthopaedic team voluntarily requested an
osteoporosis consultation on all patients with a fragility fracture. The
osteoporosis consultant evaluated patients for secondary causes and started
treatment with calcium, vitamin D, and bisphosphonates unless contraindicated.
From November 2001 to December 2003, fifty-three osteoporosis consultations
were performed. A retrospective review of the charts of all patients with a
hip fracture treated during this twenty-six-month period revealed that only
47% were actually seen by the osteoporosis consultants, creating an
unintentional "nonintervention" cohort of thirty-one patients with
a hip fracture. Treatment for osteoporosis was assessed by a review of the
inpatient charts and by a telephone interview after discharge.
Results: The study group consisted of eighty-four patients, which
included fifty-three in the intervention cohort (twenty-eight hip and
twenty-five other fractures) and thirty-one in the nonintervention cohort (all
patients with a hip fracture). In the intervention cohort, most patients were
vitamin-D deficient. Calcium and vitamin-D treatment was recommended for all
fifty-three patients, and bisphosphonates were recommended for forty-one of
the fifty-three patients in the intervention cohort. In the nonintervention
cohort, two patients received calcium and vitamin D and one received a
bisphosphonate; the difference between the cohorts was significant (p <
0.0001). In the intervention cohort, twenty-seven of the thirty-four patients
who were available for a telephone interview after discharge (at a mean of
eighteen months) remained on calcium and vitamin D; twenty-two of the
thirty-four patients remained on bisphosphonates. In the nonintervention
cohort, only one of the twelve patients who were available for follow-up (at a
mean of thirty-nine months) was receiving calcium and vitamin D and none were
on bisphosphonate treatment.
Conclusions: This consultation program cannot be considered an
outright success since only half of all patients with a hip facture actually
received a consultation. However, osteoporosis consultation, when provided,
facilitated the recognition of secondary causes and the generic treatment of
osteoporosis, and inpatients started on treatment generally continued the
medication after discharge. The results of this study strongly support the
need for a mechanism of automatic osteoporosis consultation for inpatients
with a fragility fracture and suggest that, if consultation is reliably
obtained, this approach can be effective in improving patient care.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.