Abstract
Our study investigated the patterns of treatment and adherence to prescribed therapies in 2,191 ambulatory patients with previous hip osteoporotic fractures at 207 participating orthopedic centers throughout Italy. All patients who came to the attention of the involved orthopedic surgeons were administered a questionnaire investigating: age, sex, height, weight, date of admission and length of stay in the hospital, other previous clinical fractures, bone density or biochemical testing concerning mineral metabolism, treatment with bone-active drugs in the six months before the fracture, treatment after discharge from the hospital, continuous use of prescribed drugs, pain at the site of hip surgery, and comorbidity. A multivariate logistic regression model was applied, considering a subset of the variables in the questionnaire, in order to determine the factors that significantly influenced discontinuation of treatment after hip fracture. Among the patients, 88.1% were female and 86.2% of the subjects were older than 65. The mean length of hospital stay for hip fracture was 19.0±25.3 days. At the time of interview, the mean time elapsed since hospitalization was 542.9±1,197.3 days. A previous clinical fracture was referred by 20.2% of patients. Before hip fracture occurrence, 52.8% of patients had never received any kind of treatment, and this figure reached 80% if we also included those who had taken only calcium and/or vitamin D. Corresponding proportions after fracture were 22% and 31.3%, respectively. Finally, 52% of patients had stopped treatment given for osteoporosis after a mean period of 1.4 years. According to the results of the logistic regression, increasing age, pain [odds ratio (OR): 1.36; 95% confidence interval (CI): 1.21–1.65] and no use of diagnostic tests (OR: 2.46; CI: 1.79–3.37) showed a positive effect on the probability of quitting the medication. On the other hand, being female reduces by half (OR: 0.49; CI: 0.37–0.45) the probability of quitting medication. Our data showed a low rate of primary prevention, a still insufficient post-fracture therapy, along with a high rate of early discontinuation of osteoporosis medication in patients with previous hip fracture.
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References
Ross PD (1996) Osteoporosis: frequency, consequences, and risk factors. Arch Intern Med 156:1399–1411
Office of Technology Assessment (1993) Hip fracture outcomes in people aged 50 and over: mortality, service use, expenditures, and long term functional impairment. US Department of Commerce, Congress of the United States, Washington, DC
Istituto Nazionale di Statistica (ISTAT) (1997) Previsioni della popolazione residente per sesso, età e regione. Base 1.1.1996. Rome, Italy, pp 209–226
Cummings SR, Melton LJ III (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767
Romagnoli E, Carnevale V, Calandra P, D’Erasmo E, De Geronimo S, Pepe J, Manfredi G, Maranghi M, Aliberti G, Minisola S (2003) Impact of fractures on health care in a major university hospital in Rome. Aging Clin Exp Res 15:505–511
Colon-Emeric CS, Sloane R, Hawkes WG, Magaziner J, Zimmerman SI, Pieper CF, Lyles KW (2000) The risk of subsequent fractures in community-dwelling men and male veterans with hip fracture. Am J Med 109:324–326
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739
Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C, The Osteoporosis Methodology Group and the Osteoporosis Research Advisory Group (2002) Summary of the meta-analyses of therapies for postmenopausal osteoporosis. Endocrine Rev 23:570–578
Torgerson DJ, Dolan P (1998) Prescribing by general practitioners after an osteoporotic fracture. Ann Rheum Dis 57:378–379
Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE (2000) Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 109:326–328
Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg 82:1063–1070
Solomon DH, Finkelstein JS, Katz JN, Mogun H, Avorn J (2003) Underuse of osteoporosis medications in elderly patients with fractures. Am J Med 115:398–400
Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T (2003) Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med 163:2165–2172
Bahl S, Coates PS, Greenspan SL (2003) The management of osteoporosis following hip fracture: have we improved our care? Osteoporos Int 14:884–888
Panneman MJM, Lips P, Sen SS, Herings RMC (2004) Undertreatment with anti-osteoporotic drugs after hospitalization for fracture. Osteoporos Int 15:120–124
Gardner MJ, Flik KR, Mooar P, Lane JM (2002) Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am 84:1342–1348
Simonelli C, Killeen K, Mehle S, Swanson L (2002) Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc 77:334–338
Fisher AA, Davis MH, Smith PN (2003) Undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am 85:1394–1395
Hooven F, Gehlbach SH, Pekow P, Bertone E, Benjamin E (2005) Follow-up treatment for osteoporosis after fracture. Osteoporos Int 16:296–301
Gardner MJ, Brophy RH, Demetrakopoulos D, Koob J, Hong R, Rana A, Lin JT, Lane JM (2005) Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. J Bone Joint Surg 87:3–7
Romagnoli E, Colangeli I, Minisola S (2000) Awareness, attitudes and opinions on osteoporosis of primary care physicians working in the metropolitan area of Rome: a brief report. Aging (Milano) 12:240–244
Kaufman JD, Bolander ME, Bunta AD, Edwards BJ, Fitzpatrick LA, Simonelli C (2003) Barriers and solutions to osteoporosis care in patients with a hip fracture. J Bone Joint Surg Am 85:1837–1843
Edwards BJ (2004) Solutions to the undertreatment of osteoporosis-related fractures. Arch Intern Med 164:677
Tosteson ANA, Grove MR, Hammond CS, Moncur MM, Ray GT, Hebert GM, Pressman AR, Ettinger B (2003) Early discontinuation of treatment for osteoporosis. Am J Med 115:209–216
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Carnevale, V., Nieddu, L., Romagnoli, E. et al. Osteoporosis intervention in ambulatory patients with previous hip fracture: a multicentric, nationwide Italian survey. Osteoporos Int 17, 478–483 (2006). https://doi.org/10.1007/s00198-005-0010-0
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DOI: https://doi.org/10.1007/s00198-005-0010-0