Angela Frances Yap Hui Wen1, Bernard Yap Kok Chong2, Lissa Vazhayil Joseph3, Joyce Koh Suang Bee3, Howe Tet Sen3, Kaysar Mamun4. 1. Department of Geriatric Medicine, SingHealth Residency, Singapore, Singapore. angelafrancesyhw@gmail.com. 2. Department of Geriatric Medicine, SingHealth Residency, Singapore, Singapore. 3. Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore. 4. Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore.
Abstract
Osteoporosis is often untreated especially in older people. This study found a low prescribing rate of osteoporosis treatment medication of 22.4% in older people admitted under the hip-fracture pathway. Factors associated with greater odds of being prescribed osteoporosis medications are categorized into patient-related, physician-related and system-related factors. INTRODUCTION: Osteoporosis represents a growing healthcare problem which is often overlooked by healthcare providers and untreated especially in older people. This study aims to assess the rate of osteoporosis treatment initiation and to investigate underlying physician and system-related barriers in geriatric patients admitted for hip fracture. METHODS: A retrospective study was conducted on patients aged 60 years and older, admitted under the hip-fracture pathway from January 2019 to December 2019. Data collected included demographics, co-morbid conditions and laboratory data. Clinical charts were reviewed for whether bone mineral density (BMD) scan has been ordered, plans for bone health were made and reflected in the discharge summary, and if appropriate memos were written. The primary outcome was the prescription of osteoporosis treatment medications. Prescription lists were also reviewed for prescribing patterns of calcium and vitamin D. RESULTS: A total of 375 patients older than 60 years old were identified. 281 patients who fit the inclusion and exclusion criteria with complete data were further analysed. Within 1 year of hip fracture admission, 63 (22.4%) of them were prescribed with osteoporosis treatment. Multivariate logistic regression identified milder stage of CKD (p = 0.038, OR = 0.617, 95% CI 0.392-0.973) and BMD scan performed (p < 0.001, OR = 6.515, 95% CI 3.180-13.348) as independent factors associated with the prescription of osteoporosis treatment within 1 year of hip fracture admission. CONCLUSION: The rate of osteoporosis treatment initiation post-hip fracture is low. Systematic solutions will need to be established to ensure that osteoporosis treatment is addressed prior to discharge.
Osteoporosis is often untreated especially in older people. This study found a low prescribing rate of osteoporosis treatment medication of 22.4% in older people admitted under the hip-fracture pathway. Factors associated with greater odds of being prescribed osteoporosis medications are categorized into patient-related, physician-related and system-related factors. INTRODUCTION: Osteoporosis represents a growing healthcare problem which is often overlooked by healthcare providers and untreated especially in older people. This study aims to assess the rate of osteoporosis treatment initiation and to investigate underlying physician and system-related barriers in geriatric patients admitted for hip fracture. METHODS: A retrospective study was conducted on patients aged 60 years and older, admitted under the hip-fracture pathway from January 2019 to December 2019. Data collected included demographics, co-morbid conditions and laboratory data. Clinical charts were reviewed for whether bone mineral density (BMD) scan has been ordered, plans for bone health were made and reflected in the discharge summary, and if appropriate memos were written. The primary outcome was the prescription of osteoporosis treatment medications. Prescription lists were also reviewed for prescribing patterns of calcium and vitamin D. RESULTS: A total of 375 patients older than 60 years old were identified. 281 patients who fit the inclusion and exclusion criteria with complete data were further analysed. Within 1 year of hip fracture admission, 63 (22.4%) of them were prescribed with osteoporosis treatment. Multivariate logistic regression identified milder stage of CKD (p = 0.038, OR = 0.617, 95% CI 0.392-0.973) and BMD scan performed (p < 0.001, OR = 6.515, 95% CI 3.180-13.348) as independent factors associated with the prescription of osteoporosis treatment within 1 year of hip fracture admission. CONCLUSION: The rate of osteoporosis treatment initiation post-hip fracture is low. Systematic solutions will need to be established to ensure that osteoporosis treatment is addressed prior to discharge.
Authors: Seoyoung C Kim; Mi-Sook Kim; Gabriel Sanfélix-Gimeno; Hong Ji Song; Jun Liu; Isabel Hurtado; Salvador Peiró; Joongyub Lee; Nam-Kyong Choi; Byung-Joo Park; Jerry Avorn Journal: Am J Med Date: 2015-02-03 Impact factor: 4.965
Authors: Steven R Cummings; Javier San Martin; Michael R McClung; Ethel S Siris; Richard Eastell; Ian R Reid; Pierre Delmas; Holly B Zoog; Matt Austin; Andrea Wang; Stepan Kutilek; Silvano Adami; Jose Zanchetta; Cesar Libanati; Suresh Siddhanti; Claus Christiansen Journal: N Engl J Med Date: 2009-08-11 Impact factor: 91.245
Authors: Annie W Kung; Tao Fan; Ling Xu; Wei B Xia; Il Hyung Park; Hak Sun Kim; Siew Pheng Chan; Joon Kiong Lee; Leonard Koh; Yung Kuei Soong; Suppasin Soontrapa; Thawee Songpatanasilp; Thana Turajane; Marc Yates; Shuvayu Sen Journal: BMC Womens Health Date: 2013-02-14 Impact factor: 2.809