Osteoporosis is a common disease characterized by decreased bone
mass and increased fracture risk in postmenopausal women and the
elderly. Hip fractures are among the most common consequences of
osteoporosis and unfortunately usually occur late in the course
of the disease. When a patient is admitted to the hospital with
a fragility hip fracture, a unique opportunity for diagnosis and
treatment presents itself. Fortunately, several medications have
proven to be effective in lowering the risk of future fractures.
The purposes of the present study were to test the hypothesis that
most fragility hip fractures go untreated and to determine whether educational
efforts to raise physician awareness have led to an improvement
in osteoporosis treatment rates.
A retrospective cohort study was performed with use of the patient
databases at two university medical centers and one university-affiliated
community hospital. The charts of 300 randomly selected patients
were sorted with use of ICD-9 (International Classification of Diseases,
Ninth Revision) codes for femoral neck fractures. There were 100
patients from each center, with twenty-five patients from each year between
1997 and 2000. The admitting diagnosis, mechanism of injury, admission
medications, procedures performed during hospitalization, and discharge
medications were then extracted and analyzed. During this period,
the National Osteoporosis Foundation established guiding principles
for the treatment of fragility fractures.
Of the seventy-five patients from all centers for each year from
1997 to 2000, 11%, 13%, 24%, and 29%, respectively, were discharged
with a prescription for some medication targeting osteopenia, either
supplemental calcium or an antiosteoporotic medication (estrogen,
calcitonin, a bisphosphonate, or raloxifene). A trended chi-square
analysis of this increase revealed a p value of <0.001, indicating
that this improvement in treatment was unlikely due to chance alone.
Fifty-eight (19.3%) of the 300 patients in the study received a
prescription at the time of discharge. However, forty of these patients (13.3%
of the overall group) received calcium and only eighteen (6.0% of
the overall group) received a medication to actively prevent bone
resorption and treat osteoporosis. In addition, no patient underwent
a bone density scan while in the hospital.
Elderly patients and postmenopausal women who are admitted to the
hospital and diagnosed with a low-energy femoral neck fracture have
been undertreated for osteoporosis. However, over the four years
of the present study, there was a significant increase in the rate
of treatment. It is hoped that treatment rates will continue to
increase in the future with continued educational efforts.