Abstract
Background: Patients over the age of 50 sustaining hip fractures by falling only from a standing height are at high risk for osteoporosis and recurrent fracture. Unfortunately, this group frequently leaves the hospital without any therapy to prevent future fractures. A previous survey of 183 hip fracture patients reviewed discharges for the years 1998–2000 at Scott & White Memorial Hospital and revealed an area of concern. Of this group only 48 subjects (26%) had a prior diagnosis of osteoporosis, but only 34 (19%) received bisphosphonates and 29 (16%) received hormone replacement therapy sometime during the 1 year follow-up period. This abstract describes the results of an initiative to increase the therapeutic interventions for osteoporosis in the post hip fracture patients at the Scott & White facility of the Texas A&M Health Science Center.
Methods: A clinical database was established at Scott and White to track this population. The endocrinology and orthopedic areas agreed to add calcium supplements (1500 mg daily) containing vitamin D (400 IU daily), a DEXA scan request and a consult with endocrinology to the hospital discharge orders in appropriate patients. Three hundred fifty-five patients were enrolled in the database between September 2004 and June 2006. One hundred sixty-six patients who were followed for at least 6 months and who qualified for osteoporosis medication were used for the analysis.
Results: Thirty-six (26.3%) patients used calcium supplements with vitamin D before their fracture compared to 91 (66.43%) of patients at follow-up (P <0.001). Seventeen subjects (12.41%) were taking bisphosphonates before their fracture and the number increased to 66 (48.18%) after the treatment intervention. Eighty-two patients (49.6%, P <0.001) kept the appointment for the DEXA scan and 54 (32.5 %) saw the endocrinologist.
Conclusions: The addition of calcium supplement with vitamin D to the hospital discharge medications was an effective and cost efficient method of improving treatment and enhancing compliance over the study period. Providing the opportunity for a routine endocrinology outpatient consultation after hip fracture increased the treatment of osteoporosis with effective bone active medication; however, many of the patients did not attend the consult.
- Received September 11, 2008.
