This systematic review and meta-analysis found low-quality evidence that orthogeriatric care is positively associated with diagnosis of osteoporosis, prescription of calcium and vitamin D supplements and bisphosphonates in older hip fracture patients. Evidence on fall and fracture prevention was scarce and inconclusive. Orthogeriatrics may reduce the treatment gap following hip fractures.
Hip fracture patients are at imminent risk of additional fractures and falls. Orthogeriatric care might reduce the osteoporosis treatment gap and improve outcomes in these patients. However, the optimal orthogeriatric care model (geriatric liaison service, co-management, or geriatrician-led care) remains unclear.
To summarize the association of different orthogeriatric care models for older hip fracture patients, compared to usual orthopaedic care, with fall prevention measures, diagnosis and treatment of osteoporosis and future falls and fractures.
Two independent reviewers retrieved randomized controlled trials (RCTs) or controlled observational studies. Random effects meta-analysis was applied (PROSPERO ID: 165914).
One RCT and twelve controlled observational studies were included, encompassing 20,078 participants (68% women, median ages between 75 and 85 years). Orthogeriatric care was associated with higher odds of diagnosing osteoporosis (odds ratio [OR] 11.36; 95% confidence interval [CI] 7.26–17.77), initiation of calcium and vitamin D supplements (OR 41.44; 95% CI 7.07–242.91) and discharge on anti-osteoporosis medication (OR 7.06; 95% CI 2.87–17.34). However, there was substantial heterogeneity in these findings. Evidence on fall prevention and subsequent fractures was scarce and inconclusive. Almost all studies were at high risk of bias. Evidence was insufficient to compare different care models directly against each other.
Low-quality evidence suggests that orthogeriatric care is associated with higher rates of diagnosing osteoporosis, initiation of calcium and vitamin D supplements and anti-osteoporosis medication. Whether orthogeriatric care prevents subsequent falls and fractures in older hip fracture patients remains unclear.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C, Fragility Fracture Network Rehabilitation Research Special Interest G (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158
Mitchell P, Akesson K (2018) How to prevent the next fracture. Injury 49:1424–1429
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22:465–475
Riggs BL, Melton LJ 3rd, Robb RA, Camp JJ, Atkinson EJ, Oberg AL, Rouleau PA, McCollough CH, Khosla S, Bouxsein ML (2006) Population-based analysis of the relationship of whole bone strength indices and fall-related loads to age- and sex-specific patterns of hip and wrist fractures. J Bone Miner Res 21:315–323
Conley RB, Adib G, Adler RA, Åkesson KE, Alexander IM, Amenta KC, Blank RD, Brox WT, Carmody EE, Chapman-Novakofski K, Clarke BL, Cody KM, Cooper C, Crandall CJ, Dirschl DR, Eagen TJ, Elderkin AL, Fujita M, Greenspan SL, Halbout P, Hochberg MC, Javaid M, Jeray KJ, Kearns AE, King T, Koinis TF, Koontz JS, Kužma M, Lindsey C, Lorentzon M, Lyritis GP, Michaud LB, Miciano A, Morin SN, Mujahid N, Napoli N, Olenginski TP, Puzas JE, Rizou S, Rosen CJ, Saag K, Thompson E, Tosi LL, Tracer H, Khosla S, Kiel DP (2020) Secondary fracture prevention: consensus clinical recommendations from a multistakeholder coalition. J Bone Miner Res 35:36–52
Kanis JA, Cooper C, Rizzoli R, Reginster JY, Scientific Advisory Board of the European Society for C, Economic Aspects of O, the Committees of Scientific A, National Societies of the International Osteoporosis F (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30:3–44
Lyles KW, Colon-Emeric CS, Magaziner JS et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357:1799–1809
Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 29:1929–1937
Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, Curtis JR (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 30:79–92
Mukherjee K, Brooks SE, Barraco RD, Como JJ, Hwang F, Robinson BRH, Crandall ML (2020) Elderly adults with isolated hip fractures- orthogeriatric care versus standard care: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 88:266–278
Thingstad P, Taraldsen K, Saltvedt I, Sletvold O, Vereijken B, Lamb SE, Helbostad JL (2016) The long-term effect of comprehensive geriatric care on gait after hip fracture: the Trondheim hip fracture trial--a randomised controlled trial. Osteoporos Int 27:933–942
Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Lydersen S, Halsteinli V, Saltnes T, Lamb SE, Johnsen LG, Saltvedt I (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 385:1623–1633
Dunbar J, Aspray TJ (2017) Can orthogeriatics do more than save lives? Age Ageing 46:164–165
Patel JN, Klein DS, Sreekumar S, Liporace FA, Yoon RS (2020) Outcomes in multidisciplinary team-based approach in geriatric hip fracture care: a systematic review. J Am Acad Orthop Surg 28:128–133
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, Group P-P (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1
Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Budge MM (2006) Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma 20:172–178 discussion 179-180
Tha HS, Armstrong D, Broad J, Paul S, Wood P (2009) Hip fracture in Auckland: contrasting models of care in two major hospitals. Intern Med J 39:89–94
Cogan L, Martin AJ, Kelly LA, Duggan J, Hynes D, Power D (2010) An audit of hip fracture services in the Mater Hospital Dublin 2001 compared with 2006. Ir J Med Sci 179:51–55
Deschodt M, Braes T, Broos P, Sermon A, Boonen S, Flamaing J, Milisen K (2011) Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. J Am Geriatr Soc 59:1299–1308
Gosch M, Roth T, Kammerlander C, Joosten-Gstrein B, Benvenuti-Falger U, Blauth M, Lechleitner M (2011) Treatment of osteoporosis in postmenopausal hip fracture patients after geriatric rehabilitation: changes over the last decade. Z Gerontol Geriatr 44:381–386
Gregersen M, Morch MM, Hougaard K, Damsgaard EM (2012) Geriatric intervention in elderly patients with hip fracture in an orthopedic ward. J Inj Violence Res 4:45–51
Kristensen PK, Thillemann TM, Soballe K, Johnsen SP (2016) Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study. Age Ageing 45:66–71
Heltne M, Saltvedt I, Lydersen S, Prestmo A, Sletvold O, Spigset O (2017) Patterns of drug prescriptions in an orthogeriatric ward as compared to orthopaedic ward: results from the Trondheim hip fracture trial-a randomised clinical trial. Eur J Clin Pharmacol 73:937–947
Duaso E, Formiga F, Marimon P et al (2018) Advantages of care for patients with hip fractures in the acute geriatric unit: hip study Anoia. Geriatr Gerontol Int 18:407–414
Baroni M, Serra R, Boccardi V, Ercolani S, Zengarini E, Casucci P, Valecchi R, Rinonapoli G, Caraffa A, Mecocci P, Ruggiero C (2019) The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int 30:907–916
Wu X, Tian M, Zhang J, Yang M, Gong X, Liu Y, Li X, Lindley RI, Anderson M, Peng K, Jagnoor J, Ji J, Wang M, Ivers R, Tian W (2019) The effect of a multidisciplinary co-management program for the older hip fracture patients in Beijing: a "pre- and post-" retrospective study. Arch Osteoporos 14:43
Kusen J, van der Vet P, Wijdicks FJ, Houwert M, Dijkgraaf M, Hamaker M, Geraghty O, Verleisdonk EJ, van der Velde D (2019) Different approaches towards geriatric trauma care for hip fracture patients: an inter-hospital comparison. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-019-01129-x. Online ahead of print
Rincón Gómez M, Hernández Quiles C, García Gutiérrez M, Galindo Ocaña J, Parra Alcaraz R, Alfaro Lara V, González León R, Bernabeu Wittel M, Ollero Baturone M (2020) Hip fracture co-management in the elderly in a tertiary referral hospital: a cohorts study. Rev Clin Esp 220:1–7
Shyu YI, Liang J, Tseng MY, Li HJ, Wu CC, Cheng HS, Yang CT, Chou SW, Chen CY (2013) Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture. J Gerontol A Biol Sci Med Sci 68:188–197
Knobe M, Bottcher B, Coburn M et al (2019) Geriatric Trauma Center DGU(R): evaluation of clinical and economic parameters : a pilot study in a German university hospital. Unfallchirurg 122:134–146
Joeris A, Hurtado-Chong A, Hess D, Kalampoki V, Blauth M (2017) Evaluation of the geriatric co-management for patients with fragility fractures of the proximal femur (Geriatric Fracture Centre (GFC) concept): protocol for a prospective multicentre cohort study. BMJ Open 7:e014795
Vandenbroucke A, Luyten FP, Flamaing J, Gielen E (2017) Pharmacological treatment of osteoporosis in the oldest old. Clin Interv Aging 12:1065–1077
Royal College of Physicians (2019) National Hip Fracture Database annual report 2019. RCP. https://www.nhfd.co.uk/files/2019ReportFiles/NHFD_2019_Annual_Report_v101.pdf Accessed February 6th, 2020
Ferrara MC, Andreano A, Tassistro E et al (2020) Three-year national report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients. Aging Clin Exp Res 32:1245–1253
Miki RA, Oetgen ME, Kirk J, Insogna KL, Lindskog DM (2008) Orthopaedic management improves the rate of early osteoporosis treatment after hip fracture. A randomized clinical trial. J Bone Joint Surg Am 90:2346–2353
Svenoy S, Watne LO, Hestnes I, Westberg M, Madsen JE, Frihagen F (2020) Results after introduction of a hip fracture care pathway: comparison with usual care. Acta Orthop 91:139–145
Lebanon OT, Netzer D, Yaacobi E, Berner Y, Spiegel D, Bacharach R, Nabriski D, Nyska M, Brin Y, Rotman-Pikielny P (2020) Virtual orthopedic-rehabilitation-metabolic collaboration for treating osteoporotic hip fractures. Endocr Pract 26:332–339
Axelsson KF, Johansson H, Lundh D, Möller M, Lorentzon M (2020) Association between recurrent fracture risk and implementation of fracture liaison services in four Swedish hospitals: a cohort study. J Bone Miner Res. https://doi.org/10.1002/jbmr.3990. Online ahead of print
Gonzalez-Quevedo D, Bautista-Enrique D, Perez-Del-Rio V, Bravo-Bardaji M, Garcia-de-Quevedo D, Tamimi I (2020) Fracture liaison service and mortality in elderly hip fracture patients: a prospective cohort study. Osteoporos Int 31:77–84
de Bruin IJA, Wyers CE, van den Bergh JPW, Geusens P (2017) Fracture liaison services: Do they reduce fracture rates? Ther Adv Musculoskelet Dis 9:157–164
Olsen KR, Hansen C, Abrahamsen B (2013) Association between refill compliance to oral bisphosphonate treatment, incident fractures, and health care costs--an analysis using national health databases. Osteoporos Int 24:2639–2647
Reyes C, Tebe C, Martinez-Laguna D, Ali MS, Soria-Castro A, Carbonell C, Prieto-Alhambra D (2017) One and two-year persistence with different anti-osteoporosis medications: a retrospective cohort study. Osteoporos Int 28:2997–3004
Grey A, Horne A, Gamble G, Mihov B, Reid IR, Bolland AM (2020) Ten years of very infrequent zoledronate therapy in older women: an open-label extension of a randomized trial. J Clin Endocrinol Metab 105:105: dgaa062
Javaid MK, Sami A, Lems W et al (2020) A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network. Osteoporos Int 31:1193–1204
We thank Ms. Annelore Van Heghe for her contribution to the systematic review.
Conflict of interest
The corresponding author is a geriatrician leading an orthogeriatric unit. EG and MRL are members of the Board of the Belgian Bone Club. EG has received consultancy fees from UCB, unrelated to this work. MRL is a geriatrician leading an orthogeriatric unit and has received consultancy fees from Alexion, Amgen, Kyowa Kirin, Menarini, Sandoz, Takeda, UCB, and Will-Pharma, unrelated to this work. All other authors have no relevant conflicts of interest to declare.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Van Camp, L., Dejaeger, M., Tournoy, J. et al. Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-analysis. Osteoporos Int 31, 2083–2092 (2020). https://doi.org/10.1007/s00198-020-05512-y
- Geriatric co-management
- Hip fracture
- Systematic review