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Published on: August 17, 2017
Management of Hip Fractures at an Academic Center: Challenges and Opportunities
Randa Saad1, Maya Beydoun1, Ghada El-Hajj Fuleihan2
1American University of Beirut-Medical Center, Beirut, Lebanon.
Insights
Patients with hip fractures receive inadequate osteoporosis care, indicating a significant care gap. Establishing a fracture liaison service is crucial for improving patient management and outcomes.
Area of Science:
- Geriatric Medicine
- Orthopedics
- Endocrinology
Background:
- Hip fractures are a significant health concern in older adults.
- Osteoporosis significantly increases hip fracture risk.
- Optimal management of hip fracture patients includes addressing underlying osteoporosis.
Purpose of the Study:
- To assess patient characteristics and osteoporosis-related care for hip fracture patients.
- To identify gaps in osteoporosis management at a tertiary referral center in Lebanon.
Main Methods:
- Retrospective chart review of 400 hip fracture patients (January 2011 - December 2015).
- Evaluation of demographics, clinical information, risk factors, and management received.
- Analysis included assessment and treatment for osteoporosis.
Main Results:
- Mean age was 78 years; 37% were men. Women received more assessment/treatment.
- Low rates of vitamin D assessment (39%), dietary consults (32%), and osteoporosis consults (22%).
- Discharge medications included calcium/vitamin D (25-33%), bisphosphonates (<5%). Bone mineral density testing was infrequent.
Conclusions:
- A substantial care gap exists in managing hip fracture patients regarding osteoporosis.
- National osteoporosis guidelines are not consistently followed.
- Implementing a fracture liaison service is recommended to improve care and address management barriers.
Objective:
To assess characteristics of patients with hip fractures and investigate the extent of osteoporosis-related care they receive at a tertiary referral center in Lebanon.
Methods:
A retrospective review of charts of 400 patients admitted with a hip fracture to the American University of Beirut-Medical Center, between January 1, 2011 and December 31, 2015. We reviewed medical records of adults admitted with a nonpathologic/nontraumatic hip fracture, and evaluated basic demographics and relevant clinical information, associated risk factors, and the management received.
Results:
The mean age of the population was 78 ± 10 years and men constituted 37%. Women were more likely to be assessed and/or treated. On admission, 21% were taking calcium and 18% vitamin D supplementation. During hospitalization, vitamin D level was assessed in only 39% of patients; a dietary and an osteoporosis consult were requested on only 32% and 22% of the cases, respectively. One-fourth to a third of patients were discharged on calcium or vitamin D, and less than 5% on bisphosphonates. Bone mineral density was measured in a minority although 21% had a history of previous contralateral hip fracture. One year mortality rate in a subset where follow-up available was 12% in men and 7% in women.
Conclusion:
A large care gap in the management of patients admitted with hip fracture persists despite clear national osteoporosis guidelines. This study provides a strong impetus for establishing and monitoring a fracture liaison service to understand and address barriers to providing optimal care to patients with osteoporosis.
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