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Secondary confounders of osteoporotic hip fractures in patients admitted to a geriatric acute care department

Sekundäre Confounder bei osteoporotisch bedingten Hüftfrakturen von Patienten in geriatrischen Akutstationen

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Abstract

Background

With respect to the pathogenesis of osteoporosis, primary and secondary forms of the disease can be distinguished. It has been recognized that the incidence of primary and secondary osteoporosis differs in women and men.

Objective

The aim of the present study was to assess the incidence and gender distribution of factors contributing to osteoporosis in older hip fracture patients.

Methods

In this cross-sectional study 404 patients with hip fractures and controls referred to an acute geriatric care department over a period of 15 months were included. The medical history was recorded and blood samples were analyzed for routine laboratory parameters.

Results

A total of 249 patients with hip fractures and 155 matched controls were studied. The Tinetti test and the Barthel index were found to show highly significant differences in both groups mainly because of the postoperative state of patients with fractures. Vitamin D deficiency was found in 94.1 % of male fracture patients and 94.6 % of female fracture patients. On average 2.4 secondary contributors of osteoporosis were present in male fracture patients versus 2.9 in male controls and 2.3 in female fracture patients versus 2.3 in female controls. For most parameters no significant gender differences of possible secondary contributors to osteoporosis were found. Secondary osteoporosis was diagnosed in all male fracture patients and in 56.2 % of all female fracture patients.

Conclusion

Based on the findings of this study it is recommended that hip fracture patients should be assessed for secondary contributors of osteoporosis. Although the overall distribution of secondary contributors was similar in women and men, the prevalence of secondary osteoporosis was higher in men.

Zusammenfassung

Hintergrund

Im Hinblick auf die Pathogenese lassen sich primäre und sekundäre Formen der Erkrankung unterscheiden. Die Inzidenz der primären und der sekundären Osteoporose ist bei Frauen und Männern verschieden.

Ziel

Ziel der vorgestellten Studie war die Analyse der Inzidenz und der Geschlechtsverteilung der Faktoren, die zu Osteoporose bei älteren Patienten mit Hüftfrakturen beitragen.

Methoden

In die Querschnittsstudie wurden innerhalb von 15 Monaten 404 Patienten insgesamt eingeschlossen, sowohl Patienten mit Hüftfrakturen als auch Patienten, die aus anderen Gründen auf eine Station der geriatrischen Akutversorgung aufgenommen worden waren. Die medizinische Anamnese wurde erhoben, und Routine-Laborparameter wurden in Blutproben bestimmt.

Ergebnisse

Insgesamt 249 Patienten mit Hüftfrakturen und 155 gematchte Kontrollpatienten wurden untersucht. Die Scores im Tinetti-Test und im Barthel-Index waren hoch signifikant unterschiedlich in den beiden Gruppen, vor allem bedingt durch den postoperativen Zustand der Patienten mit Frakturen. Ein Vitamin-D-Mangel bestand bei 94,1% der männlichen und 94,6% der weiblichen Patienten mit Frakturen. Durchschnittlich lagen bei den männlichen Frakturpatienten 2,4 Sekundärfaktoren für eine Osteoporose vor (vs. 2,9 bei den männlichen Kontrollpatienten) und 2,3 bei den weiblichen Frakturpatienten (vs. 2,3 bei den weiblichen Kontrollpatienten). Für die meisten Parameter zeigten sich keine signifikanten Geschlechtsunterschiede möglicher sekundärer Faktoren für die Entwicklung einer Osteoporose. Die Diagnose sekundäre Osteoporose wurde bei allen männlichen und bei 56,2% der weiblichen Patienten gestellt.

Schlussfolgerung

Auf der Basis der Ergebnisse dieser Studie wird empfohlen, dass Patienten mit Hüftfrakturen auf Faktoren untersucht werden, die zu einer sekundären Osteoporose beitragen. Zwar erwies sich die Verteilung dieser Faktoren als insgesamt ähnlich bei Männern und Frauen, doch die Prävalenz der sekundären Osteoporose war bei Männern höher.

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Acknowledgements

The authors are grateful to Irene Seiringer, Gerald Lahnsteiner, Augustine Wenzel, Sandra Wurz, Caroline Koch, Andrea Eisl, Andrea Huber, Gertrude Lukas, Brigitte Ettinger, Andrea Holzmann, Gisela Zausek, and Claudia Dopf for technical and logistic support.

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Authors and Affiliations

  1. Department of Geriatric Acute Care, Salzkammergut-Klinikum Gmunden, Miller von Aichholzstraße 49, 4810, Gmunden, Austria

    Peter Dovjak MD, Maarit Konrad MD & Bernhard Bichler MD

  2. Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Spitalsgasse 23, 1090, Vienna, Austria

    Ursula Föger-Samwald &  Peter Pietschmann

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  1. Peter Dovjak MD
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  2. Ursula Föger-Samwald
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Correspondence to Peter Dovjak MD.

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Conflict of interest

P. Dovjak has received research support or speaker honoraria from Daichi Sankyo, Nutricia, Novartis, Bristol-Myers Squibb and Bayer. U. Föger-Samwald and B. Bichler have no conflicts of interest. M. Konrad has received speaker honoraria from Bristol Myers Squibb and Roche Austria. P. Pietschmann has received research support and/or honoraria from Amgen, Eli Lilly, Fresenius Kabi, Merck, Sharp and Dohme, Novartis Pharma, Nycomed Pharma, Roche Austria, Servier Austria, Sanofi Austria and Sinapharm.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Dovjak, P., Föger-Samwald, U., Konrad, M. et al. Secondary confounders of osteoporotic hip fractures in patients admitted to a geriatric acute care department. Z Gerontol Geriat 48, 633–640 (2015). https://doi.org/10.1007/s00391-014-0821-8

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  • DOI: https://doi.org/10.1007/s00391-014-0821-8

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