BACKGROUND: Screening and management of osteoporosis is often only considered by providers when patients present with multiple fragility fractures. The objective was to determine which patients are at risk for not receiving anti-osteoporotic medication and screening immediately following open reduction internal fixation (ORIF) for hip fracture. METHODS: The 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture Database was queried to identify patients ≥ 50 years old who underwent ORIF of femoral neck, intertrochanteric hip, and subtrochanteric hip fractures. Patients with concurrent polytrauma, malignancy, and other fragility fractures were excluded. Patients taking osteoporotic medications immediately prior to hospitalization were excluded to prevent an overlap in the screening and/or antiresorptive medication initiation rates. Multi-variate logistic regression was used to assess for factors associated with not receiving anti-osteoporotic medication immediately postoperatively. RESULTS: A total of 6179 patients were identified of whom 3304 (53.5%) were treated at a facility with a documented standardized hip fracture care program. Only 28.5% (N = 1766) patients received anti-osteoporosis medication immediately following ORIF. Independent factors associated with increased odds of not initiating bone protective medication were those without a standardized hip fracture care program (odds ratio [OR] 1.80 [1.58-2.06], P < 0.001), length of stay ≤ 5 days (odds ratio [OR] 1.47 [1.28-1.69], P < 0.001), patients waiting > 1 day until operation (odds ratio [OR] 1.35 [1.13-1.60], P = 0.001), patients requiring a mobility aid preoperatively (odds ratio [OR] 1.29 [1.13-1.47], P < 0.001), and patients who could not weight bear as tolerated (WBAT) on postoperative day 1 (POD 1) (odds ratio [OR] 1.25 [1.06-1.47], P = 0.008). CONCLUSION: Patients starting anti-osteoporotic medication immediately following a hip fracture in the United States remains low (28.5%). Standardized hip fracture care programs have the greatest impact with regards to initiating anti-osteoporotic medication following hip fracture.
BACKGROUND: Screening and management of osteoporosis is often only considered by providers when patients present with multiple fragility fractures. The objective was to determine which patients are at risk for not receiving anti-osteoporotic medication and screening immediately following open reduction internal fixation (ORIF) for hip fracture. METHODS: The 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture Database was queried to identify patients ≥ 50 years old who underwent ORIF of femoral neck, intertrochanteric hip, and subtrochanteric hip fractures. Patients with concurrent polytrauma, malignancy, and other fragility fractures were excluded. Patients taking osteoporotic medications immediately prior to hospitalization were excluded to prevent an overlap in the screening and/or antiresorptive medication initiation rates. Multi-variate logistic regression was used to assess for factors associated with not receiving anti-osteoporotic medication immediately postoperatively. RESULTS: A total of 6179 patients were identified of whom 3304 (53.5%) were treated at a facility with a documented standardized hip fracture care program. Only 28.5% (N = 1766) patients received anti-osteoporosis medication immediately following ORIF. Independent factors associated with increased odds of not initiating bone protective medication were those without a standardized hip fracture care program (odds ratio [OR] 1.80 [1.58-2.06], P < 0.001), length of stay ≤ 5 days (odds ratio [OR] 1.47 [1.28-1.69], P < 0.001), patients waiting > 1 day until operation (odds ratio [OR] 1.35 [1.13-1.60], P = 0.001), patients requiring a mobility aid preoperatively (odds ratio [OR] 1.29 [1.13-1.47], P < 0.001), and patients who could not weight bear as tolerated (WBAT) on postoperative day 1 (POD 1) (odds ratio [OR] 1.25 [1.06-1.47], P = 0.008). CONCLUSION: Patients starting anti-osteoporotic medication immediately following a hip fracture in the United States remains low (28.5%). Standardized hip fracture care programs have the greatest impact with regards to initiating anti-osteoporotic medication following hip fracture.
Authors: R Rizzoli; S L Greenspan; G Bone; T J Schnitzer; N B Watts; S Adami; A J Foldes; C Roux; M A Levine; B Uebelhart; A C Santora; A Kaur; C A Peverly; J J Orloff Journal: J Bone Miner Res Date: 2002-11 Impact factor: 6.741
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Authors: Nguyen D Nguyen; Henrik G Ahlborg; Jacqueline R Center; John A Eisman; Tuan V Nguyen Journal: J Bone Miner Res Date: 2007-06 Impact factor: 6.741
Authors: Robert B Conley; Gemma Adib; Robert A Adler; Kristina E Åkesson; Ivy M Alexander; Kelly C Amenta; Robert D Blank; William Timothy Brox; Emily E Carmody; Karen Chapman-Novakofski; Bart L Clarke; Kathleen M Cody; Cyrus Cooper; Carolyn J Crandall; Douglas R Dirschl; Thomas J Eagen; Ann L Elderkin; Masaki Fujita; Susan L Greenspan; Philippe Halbout; Marc C Hochberg; Muhammad Javaid; Kyle J Jeray; Ann E Kearns; Toby King; Thomas F Koinis; Jennifer Scott Koontz; Martin Kužma; Carleen Lindsey; Mattias Lorentzon; George P Lyritis; Laura Boehnke Michaud; Armando Miciano; Suzanne N Morin; Nadia Mujahid; Nicola Napoli; Thomas P Olenginski; J Edward Puzas; Stavroula Rizou; Clifford J Rosen; Kenneth Saag; Elizabeth Thompson; Laura L Tosi; Howard Tracer; Sundeep Khosla; Douglas P Kiel Journal: J Orthop Trauma Date: 2020-04 Impact factor: 2.512