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Undertreatment of osteoporosis in men with hip fracture
Gary M Kiebzak1, Garth A Beinart, Karen Perser
1Center for Orthopaedic Research and Education, St Luke's Episcopal Hospital, 6720 Bertner Ave, Mail Stop MC4-183, Houston, TX 77030, USA. gkiebzak@sleh.com
Insights
Men with hip fractures receive significantly less osteoporosis treatment than women, despite similar fracture causes and higher mortality rates. Few men receive adequate post-fracture care, leading to increased disability.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Public Health
Background:
- Osteoporosis treatment is often inadequate for women post-hip fracture.
- The treatment status of men after hip fracture is not well-documented.
Purpose of the Study:
- To assess the outcomes and osteoporosis treatment patterns in men following hip fracture.
- To compare male and female hip fracture patient treatment and outcomes.
Main Methods:
- Retrospective analysis of 363 hip fracture patients (110 men, 253 women) aged 50+.
- Data collection included medical records and 1- to 5-year follow-up surveys.
- Outcome variables: osteoporosis treatment, bone mineral density testing, mortality, disability, and living arrangements.
Main Results:
- Men had higher 12-month mortality (32% vs. 17%) and significantly less osteoporosis treatment at discharge (4.5% vs. 27%) and follow-up (27% vs. 71%) compared to women.
- A higher proportion of men receiving treatment were only on calcium and vitamin D (67% vs. 32%).
- Men had lower rates of bone mineral density testing (11% vs. 27%) and increased post-discharge disability.
Conclusions:
- Hip fractures lead to substantial disability and mortality in both sexes.
- Men with hip fractures are significantly undertreated for osteoporosis, particularly with antiresorptive medications.
- Current post-fracture care for men is insufficient, contributing to poor outcomes.
Background:
Women are not aggressively treated for osteoporosis after hip fracture; the treatment status of men with hip fracture has not been extensively studied.
Objective:
To evaluate the outcome and treatment status of men with hip fracture.
Methods:
Data from medical records were obtained for 363 patients (110 men and 253 women) aged 50 years and older with atraumatic (low-energy) hip fracture who were admitted to St Luke's Episcopal Hospital between January 1, 1996, and December 31, 2000. Surveys were mailed to surviving patients. Main outcome variables were osteoporosis treatments (antiresorptive or calcium and vitamin D) at hospital discharge, current osteoporosis treatments at 1- to 5-year follow-up, bone mineral density testing, mortality, current disability, and living arrangements (home or institution).
Results:
The mean age for men was 80 years vs 81 years for women. Most fractures (89% for men and 93% for women) resulted from falls from a standing height. At hospital discharge, 4.5% of men (n = 5) had treatment of any kind for osteoporosis, compared with 27% of women (n = 69) (P<.001). The 12-month mortality was 32% in men, compared with 17% in women (P =.003). Surveys were usable from 168 (87%) of 194 survivors. At 1- to 5-year follow-up, 27% (12/44) of men were taking treatment of any kind for osteoporosis, compared with 71% (88/124) of women (P<.001). Of those treated, 67% (8/12) of men and 32% (28/88) of women were taking calcium and vitamin D only. At 1- to 5-year follow-up, 11% of men had a bone mineral density measurement, compared with 27% of women. After hospital discharge, the number of men and women who required wheelchairs, walkers, and canes and who lived in institutions increased significantly.
Conclusions:
The burden of hip fracture is illustrated by the high incidence of postfracture disability and the high mortality rate in both men and women. Nevertheless, few men receive antiresorptive treatment.
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