Abstract
This study examined post-fracture osteoporosis drug treatment in hip fracture patients and the association of treatment with mortality and morbidity. Pre- and post-fracture demographic/health information was collected on a cohort of hip fracture patients aged 65+ years. Post-fracture administrative data on prescription drug use and health care utilization was linked to the cohort data. Five classes of osteoporosis drugs were available during the study period: hormone replacement therapy (HRT), bisphosphonates (BSP), calcitonin, selective estrogen receptor modulators (SERMs) and vitamin D3 (Rocaltrol). Pre-fracture, 38 of 449 patients (8%) were on osteoporosis medications. Post-fracture, 81 of 356 patients (23%) were treated; 63 of these patients were untreated prior to fracture. Both treated and untreated patients had similar rates of subsequent hip fracture (6% and 4%, respectively) and Colles fracture (2%). Regardless of treatment status, patients were also equally likely to be hospitalized, both in the short-term (28% in treated, 27% in untreated) and in the long-term (43% versus 37%). However, mortality was significantly lower in the treated group. The lower mortality in the treated group, combined with the knowledge that antiresorptive drugs reduce fractures and increase bone density, merit undertaking a randomized trial to confirm our findings that antiresorptive therapy should be considered in all patients post-hip fracture.
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References
National Osteoporosis Foundation (1989) Report of the Task Force of the National Osteoporosis Foundation: clinical indications for bone mass measurements. J Bone Miner Res 4:1–28
Wolinsky FD, Fitzgerald JF, Stump TE (1997) The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 87:398–403
Marottoli RA, Berkman LF, Cooney LM Jr (1992) Decline in physical function following hip fracture. J Am Geriatr Soc 40:861–866
Salkeld G, Cameron ID, Cumming RG et al. (2000) Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 320:341–346
Murphy J, Isaacs B (1982) The post-fall syndrome. A study of 36 elderly patients. Gerontology 28:265–270
Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 163:819–822
Juby AG, De Geus-Wenceslau CM (2002) Evaluation of osteoporosis in seniors after hip fracture. Osteoporos Int 13:205–210
Mainous AG III, Gill JM (1998) The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician? Am J Public Health 88:1539–1541
Cree M, Soskolne CL, Belseck E et al. (2000) Mortality and institutionalization following hip fracture. J Am Geriatr Soc 48:283–288
Steinwachs DM (1979) Measuring provider continuity in ambulatory care: an assessment of alternative approaches. Med Care 18:551–565
Wartski SA, Green DS (1971) Evaluation in home-care program. Med Care 9:352–364
Dirschl DR, Piedrahita L, Henderson RC (2000) Bone mineral density 6 years after a hip fracture: a prospective, longitudinal study. Bone 26:95–98
McClung MR, Geusens P, Miller PD et al. (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340
Black DM, Cummings SR, Karpf DB et al. (1996) Randomised trial of the effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research group. Lancet 348:1535–1541
Magaziner J, Hawkes W, Hebel JR et al. (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507
March LM, Cameron ID, Cumming RG et al. (2000) Mortality and morbidity after hip fracture: can evidence based clinical pathways make a difference? J Rheumatol 27:2227–2231
Marottoli RA, Berkman LF, Leo-Summers L et al. (1994) Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE cohort. Established Populations for Epidemiologic Studies of the Elderly. Am J Public Health 84:1807–1812
McKercher HG, Crilly RG, Kloseck M (2000) Osteoporosis management in long-term care. Can Fam Phys 46:2228–2235
Yuen CK, Kendler D, Khan A, Brown J, Fortier M (2001) Canadian consensus on menopause and osteoporosis: osteoporosis. J Obstet Gynecol Can :XX1–XX11
Scientific Advisory Board (1996) Clinical practice guidelines for the diagnosis and management of osteoporosis. CMAJ 155:1113–1133
Davis DA, Taylor-Vaisey A (1997) Translating guidelines into practice. CMAJ 157:408–416
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This research was funded by the Alberta Heritage Foundation for Medical Research.
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Cree, M.W., Juby, A.G. & Carriere, K.C. Mortality and morbidity associated with osteoporosis drug treatment following hip fracture. Osteoporos Int 14, 722–727 (2003). https://doi.org/10.1007/s00198-003-1430-3
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DOI: https://doi.org/10.1007/s00198-003-1430-3