Preliminary Data From a Geriatrician-Led Program for Orthopedic Co-Managed Hip Fracture Patients Using Zoledronic
Karen Chahal1, Jessica Nguyen2, Diviya Rajesh3
1Beth Israel Deaconess Medical Center, Department of Medicine, Division of Gerontology & Harvard Medical School, Boston, Massachusetts, USA.
Background:
Hip fractures are increasing as the U.S. population ages and result in significant morbidity, mortality, and cost. Despite guidelines recommending osteoporosis treatment after hip fracture, few patients receive treatment. To address this unmet need, our large, tertiary care, academic hospital initiated an inpatient osteoporosis treatment program with Zoledronic Acid (ZA) led by a single geriatrician co-managing patients with hip fracture admitted to the orthopedic trauma service. This study describes the program's implementation and preliminary data.
Methods:
A prospective cohort of older adults (>/= 65 years) with surgically repaired hip fractures at a single academic center were included from September 12th, 2022, through May 17th, 2024. The ZA program was initiated by geriatrics in collaboration with other specialties, including nursing and pharmacy. Co-managed hip fracture patients were screened for ZA. Eligibility criteria included creatinine clearance >/= 35 mL/min and Vitamin D level >/= 20 ng/mL. The RE-AIM framework was utilized to evaluate the program's implementation: Reach (number of patients admitted, screened and eligible), effectiveness (eligible patients who received ZA, reasons for ineligibility), adoption (time spent) and implementation (program cost).
Results:
During a twenty-month period, 232 hip fracture patients with a mean age of 83.8 years were admitted to co-managed care, of which 74% were female. 148 patients were screened for ZA; 67 (45.3%) were eligible, and 58 (39.2%) received ZA prior to hospital discharge. The most common reasons for ineligibility were low vitamin D (32.1%), inadequate kidney function (21%) and previous or current osteoporosis treatment in the outpatient setting (29.6%). No adverse reactions or delays in discharge were noted among treated patients. On average, 30 min were spent on screening and treatment.
Conclusion:
A co-managed inpatient ZA program led by a single geriatrician appears to be a feasible strategy to treat osteoporosis among hospitalized patients with hip fracture.
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