Low rates of osteoporosis treatment after hospitalization for hip fracture in Hawaii

Disparities in the Epidemiology and Management of Fragility Hip Fractures

PURPOSE OF REVIEW

The purpose of this review is to synthesize the recently published scientific evidence on disparities in epidemiology and management of fragility hip fractures.

RECENT FINDINGS

There have been a number of investigations focusing on the presence of disparities in the epidemiology and management of fragility hip fractures. Race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities have been the primary focus of these investigations. Comparatively fewer studies have focused on why these disparities may exist and interventions to reduce disparities. There are widespread and profound disparities in the epidemiology and management of fragility hip fractures. More studies are needed to understand why these disparities exist and how they can be addressed.

Early bisphosphonate therapy post proximal femoral fracture fixation does not impact fracture healing: a systematic review and meta-analysis

BACKGROUND

There is conjecture on the optimal timing to administer bisphosphonate therapy following operative fixation of low-trauma hip fractures. Factors include recommendations for early opportunistic commencement of osteoporosis treatment, and clinician concern regarding the effect of bisphosphonates on fracture healing. We performed a systematic review and meta-analysis to determine if early administration of bisphosphonate therapy within the first month post-operatively following proximal femur fracture fixation is associated with delay in fracture healing or rates of delayed or non-union.

METHODS

We included randomized controlled trials examining fracture healing and union rates in adults with proximal femoral fractures undergoing osteosynthesis fixation methods and administered bisphosphonates within 1 month of operation with a control group. Data were pooled in meta-analyses where possible. The Cochrane Risk of Bias Tool and the GRADE approach were used to assess validity.

RESULTS

For the outcome of time to fracture union, meta-analysis of three studies (n = 233) found evidence for earlier average time to union for patients receiving early bisphosphonate intervention (MD = -1.06 weeks, 95% CI -2.01--0.12, I²  = 8%). There was no evidence from two included studies comprising 718 patients of any difference in rates of delayed union (RR 0.61, 95% CI 0.25-1.46). Meta-analyses did not demonstrate a difference in outcomes of mortality, function or pain.

CONCLUSIONS

We provide low-level evidence that there is no reduction in time to healing or delay in bony union for patients receiving bisphosphonates within 1 month of proximal femur fixation.

Osteoporosis identification among previously undiagnosed individuals with vertebral fractures

Because osteoporosis is under-recognized in patients with vertebral fractures, we evaluated characteristics associated with osteoporosis identification. Most patients with vertebral fractures did not receive evaluation or treatment for osteoporosis. Black, younger, and male participants were particularly unlikely to have had recognized osteoporosis, which could increase their risk of negative outcomes.

INTRODUCTION

Vertebral fractures may be identified on imaging but fail to prompt evaluation for osteoporosis. Our objective was to evaluate characteristics associated with clinical osteoporosis recognition in patients who had vertebral fractures detected on their thoracolumbar spine imaging reports.

METHODS

We prospectively identified individuals who received imaging of the lower spine at primary care clinics in 4 large healthcare systems who were eligible for osteoporosis screening and lacked indications of osteoporosis diagnoses or treatments in the prior year. We evaluated characteristics of participants with identified vertebral fractures that were associated with recognition of osteoporosis (diagnosis code in the health record; receipt of bone mineral density scans; and/or prescriptions for anti-osteoporotic medications). We used mixed models to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs).

RESULTS

A total of 114,005 participants (47% female; mean age 65 (interquartile range: 57-72) years) were evaluated. Of the 8579 (7%) participants with vertebral fractures identified, 3784 (44%) had recognition of osteoporosis within the subsequent year. In adjusted regressions, Black participants (OR (95% CI): 0.74 (0.57, 0.97)), younger participants (age 50-60: 0.48 (0.42, 0.54); age 61-64: 0.70 (0.60, 0.81)), and males (0.39 (0.35, 0.43)) were less likely to have recognized osteoporosis compared to white participants, adults aged 65 + years, or females.

CONCLUSION

Individuals with identified vertebral fractures commonly did not have recognition of osteoporosis within a year, particularly those who were younger, Black, or male. Providers and healthcare systems should consider efforts to improve evaluation of osteoporosis in patients with vertebral fractures.

Uptake of osteoporosis treatment recommended by an orthogeriatrics service after hip fracture: Retrospective cohort study of prevalence and potential barriers and enablers at a tertiary referral hospital in Sydney

OBJECTIVES

The primary aim was to determine the 12-month period prevalence of and time to osteoporosis treatment following minimal trauma hip fractures in patients who were recommended treatment by an orthogeriatrics service. The secondary aim was to determine the factors associated with receiving treatment including the impact of osteoporosis clinic follow-up.

METHODS

A retrospective cohort study of patients with minimal trauma hip fractures admitted at a tertiary hospital in Sydney between 1 April 2017 and 31 March 2019 was performed. Baseline characteristics were collected from medical records. Osteoporosis treatment data were collected from patients and general practitioners. Univariate and multivariate logistic regression analyses were used to determine the factors associated with receiving osteoporosis treatment.

RESULTS

There were 189 participants who consented to participate with a mean age of 84.6 years. Most (76.7%) were females, 18.5% were nursing home residents, 70.9% had normal cognition, 20.6% were taking osteoporosis treatment prior to admission, 61.9% had osteoporosis treatment recommendations documented on the discharge summary, and 10.1% were followed up in the osteoporosis clinic. Ninety-eight patients (51.9%) received treatment within the first 12 months after fracture with a median time to treatment of 90 days. Factors associated with receiving osteoporosis treatment within 12 months on multivariate analysis included normal cognition (p = 0.03), taking osteoporosis treatment prior to admission (p < 0.001), including treatment recommendations in the discharge summary (p = 0.006) and osteoporosis clinic follow-up (p < 0.001).

CONCLUSIONS

Osteoporosis treatment after hip fracture remains suboptimal at this hospital. Patient and health service factors associated with treatment uptake could inform future quality improvement work.

Educational program for orthopedic surgeons' influences for osteoporosis

Background

In this retrospective study, we studied the impact of educational osteoporosis program on the rates of bone mineral density (BMD) assessment and bone turnover markers (BTM) and drug medications in the patients with hip fracture.

Methods

This retrospective research enrolled 651 patients aged ≥50 years who experienced hip fractures from January 2013 to December 2015. We recorded whether patients had received BMD assessment, BTM measurement, and anti-osteoporosis therapy during the period of hospitalization. Orthopedic surgeons were classified into the trained group and the untrained group. The rates of BMD assessment, BTM measurement, and anti-osteoporosis medications in the patients with hip fracture were compared between the trained group and the untrained group.

Results

BMD assessment was performed in 109/220 patients in the trained group and 142/431 patients in the untrained group. BTM measurements were performed in 130 patients in the trained group and 124 patients in the untrained group. Forty eight patients in the trained group and 63 patients in the untrained group received bisphosphonate medications.

Conclusions

Although the rates of BMD assessment, BTM measurement, and bisphosphonate use in the patients after hip fractures are still insufficient, education programs help to improve the situation.

Osteoporosis treatment rates after hip fracture 2011-2019 in Hawaii: Undertreatment of men after hip fractures

Objectives

To investigate trends of osteoporosis treatment rates, and factors affecting osteoporosis treatment after hip fracture admission within a single health care system in Hawaii.

Methods

A retrospective chart review was conducted of patients aged 50 years or older and hospitalized for hip fractures between January 1, 2011 and December 31, 2019 at Hawaii Pacific Health, a large health care system in Hawaii. We collected data on basic demographics and osteoporosis medication prescription from electronic medical records. We evaluated trends of osteoporosis treatment rates and performed logistic regression to determine factors associated with osteoporosis treatment.

Results

The mean for treatment rates for osteoporosis from 2011 to 2019 was 17.2% (range 8.8%–26.0%). From 2011 to 2019 there was a small increase in treatment rates from 16.3% in 2011 to 24.1% in 2019. Men were less likely to receive osteoporosis treatment after admission for hip fracture. Patients discharged to a facility were more likely to receive osteoporosis treatment. As compared to women, men who had a hip fracture were less likely to receive dual-energy X-ray absorptiometry scan, and osteoporosis medication before hip fracture admission.

Conclusions

The use of osteoporosis medication for secondary prevention after admission for hip fracture in Hawaii from 2011 to 2019 was low. However, there was a small increase in treatment rates from 2011 to 2019. Disparities in treatment of osteoporosis after hip fracture were noted in men. Significant work is needed to increase treatment rates further, and to address the disparity in osteoporosis treatment between men and women.

The treatment gap after major osteoporotic fractures in Denmark 2005-2014: a combined analysis including both prescription-based and hospital-administered anti-osteoporosis medications

This study demonstrates a substantial and persistent anti-osteoporosis treatment gap in men and women ≥50 years old who sustained major osteoporotic fracture(s) between 2005 and 2014 in Denmark. This was not substantially reduced by including hospital-administered anti-osteoporosis treatments. Strengthened post-fracture organization of care and secondary fracture prevention is highly needed.

INTRODUCTION

The purpose of this study was to evaluate the Danish anti-osteoporosis treatment gap from 2005 to 2014 in patients sustaining a major osteoporotic fracture (MOF), and to assess the impact of including hospital-administered anti-osteoporosis medications (AOM) on the treatment gap among these patients.

METHODS

In this retrospective, registry-based study, we included men and women aged 50 years or older and living in Denmark, who sustained at least one MOF between 2005 and 2014. We applied a repeated cross-sectional design to generate cohorts of patients sustaining a first MOF, hip, vertebral, humerus, or forearm fracture, respectively, within each calendar year. We evaluated the treatment gap as the proportion of patients within each cohort not receiving treatment with AOM within 1 year of the fracture. Hospital-administered AOM was identified by SKS code.

RESULTS

The treatment gap among MOF patients decreased from 85% in 2005 to 79% in 2014. The gap was smaller among hip and vertebral fracture patients as compared to humerus and forearm fracture patients, and it was smaller in women than in men. The use of hospital-administered AOM was relatively uncommon, with a maximum of 0.9% of MOF patients initiating hospital-administered AOM (in 2012). We observed substantial variations in this proportion between fracture types and gender. Hospital-administered AOM was most commonly used among vertebral fracture patients.

CONCLUSION

A significant treatment gap among patients sustaining a major osteoporotic fracture was present throughout our analysis, and including hospital-administered AOM did not significantly improve the treatment gap assessment. Improved secondary fracture prevention is urgently needed.

Fracture Risk Assessment: An Update

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Our ability to accurately identify high fracture risk in individuals has improved as the volume of clinical data has expanded and fracture risk assessment tools have been developed.

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Given its accessibility, affordability, and low radiation exposure, dual x-ray absorptiometry (DXA) remains the standard for osteoporosis screening and monitoring response to treatment.

➤

The trabecular bone score (TBS) is a DXA software add-on that uses lumbar spine DXA imaging to produce an output that correlates with bone microarchitecture. It has been identified as an independent fracture risk factor and may prove useful in further stratifying fracture risk among those with a bone mineral density (BMD) in the osteopenic range (-1.0 to -2.4 standard deviations), in those with low-energy fractures but normal or only mildly low BMD, or in those with conditions known to impair bone microarchitecture.

➤

Fracture risk assessment tools, including the Fracture Risk Assessment Tool (FRAX), Garvan fracture risk calculator, and QFracture, evaluate the impact of multiple clinical factors on fracture risk, even in the absence of BMD data. Each produces an absolute fracture risk output over a defined interval of time. When used appropriately, these enhance our ability to identify high-risk patients and allow us to differentiate fracture risk among patients who present with similar BMDs.

➤

For challenging clinical cases, a combined approach is likely to improve accuracy in the identification of high-risk patients who would benefit from the available osteoporosis therapies.

Clinical characteristics and outcomes of patients presenting with hip fractures at a tertiary care hospital in Pakistan

Osteoporosis remains under-recognized and sub-optimally managed in Pakistan, with a lack of awareness that minimal impact hip fracture is a manifestation of low bone mineral density (BMD).

PURPOSE

Hip fracture is often the first clinical presentation of osteoporosis and an opportunity to intervene and reduce future fracture risk. Our aim was to understand the current practices in Pakistan related to bone health in patients presenting with a hip fracture.

METHODS

This is a retrospective study at a tertiary care center in Pakistan of patients admitted with a hip fracture. Data collected includes previous fracture history, known preceding diagnosis of low BMD medication details, comorbidities, and DXA results.

RESULTS

Two hundred ten patients were studied. The mean age of patients was 73.1 years, with 112 (53.3%) women. Most (195 (92.9%)) had presented with a low-impact hip fracture, with 17 (8.1%) reporting previous history of fracture. None had been treated with osteoporosis medications prior to fracture. Nineteen (9%) were on calcium and vitamin D supplements prior to fracture; of the minority who were screened, all were vitamin D deficient and subsequently discharged on vitamin D supplements. No one was prescribed medications to reduce fracture risk at discharge.

CONCLUSION

This study reveals that patients admitted with minimal impact hip fractures in Pakistan are rarely evaluated for low BMD and not started on osteoporosis medications even after presenting with a typical osteoporosis-related fracture. This underscores the need for health provider education about osteoporosis as a major cause for hip fractures and the need to intervene for future fracture risk reduction.

Osteoporotic hip fracture mortality and associated factors in Hawai'i

The 30-day mortality of osteoporotic hip fracture patients ≥ 50 years at Hawai'i Pacific Health (2015-2016) was 4.2%. Mortality increased to 17.1% (1 year), 24.5% (2 years), and 30.1% (3 years). Increased age, male sex, higher CCI score, primary insurance status-Medicare/Medicaid, and lower BMI were associated with increased mortality.

PURPOSE

The objective of this study was to evaluate mortality and factors associated with mortality of osteoporotic hip fracture patients at community hospitals within a large healthcare system in Hawai'i.

METHODS

A retrospective chart review was conducted of 428 patients, ≥ 50 years, and hospitalized for a osteoporotic hip fracture from January 2015 to May 2016 within a large healthcare system in Hawai'i. Patient demographics, comorbidities, and treatment were collected from retrospective chart review. We determined the date of death by review of medical records and online public obituary records. We calculated 30-day, 90-day, 1-year, 2-year, and 3-year mortality after discharge for hip fracture admission. Multivariable logistic regression and proportional hazards regression were used to evaluate associations between variables and the mortality of the patients.

RESULTS

The 30-day and 90-day mortality after admission for hip fracture were 4.2% and 8.6%. One-year mortality, 2-year mortality, and 3-year mortality were 17.1%, 24.5%, and 30.1%, respectively. Through proportional hazards regression, older age (hazard ratio (HR) = 1.06, p < 0.001), high comorbidity load (HR = 1.30, p < 0.001), and primary insurance status-Medicare/Medicaid (HR = 3.78, p = 0.021) were associated with increased mortality, while female sex (HR = 0.54, p < 0.001) and higher BMI (HR = 0.94, p = 0.002) were associated with lower mortality.

CONCLUSION

After admission for osteoporotic hip fracture, the 30-day mortality was 4.2%. At 1 year, 2 years, and 3 years, mortality increased to 17.1%, 24.5%, and 30.1%, respectively. Increased age, male sex, higher Charlson comorbidity index score, primary insurance status-Medicare/Medicaid, and lower body mass index were associated with increased mortality.

Management of Hip Fractures at an Academic Center: Challenges and Opportunities

OBJECTIVE

To assess characteristics of patients with hip fractures and investigate the extent of osteoporosis-related care they receive at a tertiary referral center in Lebanon.

METHODS

A retrospective review of charts of 400 patients admitted with a hip fracture to the American University of Beirut-Medical Center, between January 1, 2011 and December 31, 2015. We reviewed medical records of adults admitted with a nonpathologic/nontraumatic hip fracture, and evaluated basic demographics and relevant clinical information, associated risk factors, and the management received.

RESULTS

The mean age of the population was 78 ± 10 years and men constituted 37%. Women were more likely to be assessed and/or treated. On admission, 21% were taking calcium and 18% vitamin D supplementation. During hospitalization, vitamin D level was assessed in only 39% of patients; a dietary and an osteoporosis consult were requested on only 32% and 22% of the cases, respectively. One-fourth to a third of patients were discharged on calcium or vitamin D, and less than 5% on bisphosphonates. Bone mineral density was measured in a minority although 21% had a history of previous contralateral hip fracture. One year mortality rate in a subset where follow-up available was 12% in men and 7% in women.

CONCLUSION

A large care gap in the management of patients admitted with hip fracture persists despite clear national osteoporosis guidelines. This study provides a strong impetus for establishing and monitoring a fracture liaison service to understand and address barriers to providing optimal care to patients with osteoporosis.

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed.

INTRODUCTION

Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an anti-osteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015.

METHODS

This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture.

RESULTS

A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women.

CONCLUSION

Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.

The Fracture Liaison Service to close the osteoporosis care gap: a leadership educational model for undergraduate and postgraduate trainees

Osteoporotic fractures have been rising and are a cause of severe morbidity and mortality. Care gaps exist in osteoporosis treatment and diagnosis, which presents an opportunity for education. A number of healthcare systems in the world have developed a fracture liaison service (FLS) to combat osteoporotic fractures. The Rheumatology division at Loma Linda University Health (LLUH) developed an FLS not only to address osteoporosis care gaps but to also develop a new educational model. An interdisciplinary model of osteoporosis care has been implemented along with a revamp of educational focus on osteoporosis and bone health in the rheumatology fellowship and internal medicine residency. Pre-LLUH FLS studies showed that 85% of patients pre-fracture were never screened nor treated for osteoporosis; post-fracture, only 10% of patients were treated, and only 6% had dual x-ray absorptiometry (DXA). Notably, 30% had a prior fracture. We discuss how the FLS has served as a catalyst for education, not only at our academic center but also as an outreach for our community in order to elevate the care of osteoporosis in our community.Key Points• Care gaps exist in osteoporosis treatment and are addressed by the Fracture Liaison Service.• The Loma Linda University Health Fracture Liaison Service is an interdisciplinary program.• The Fracture Liaison Service is an educational model that gives hands on learning through an amalgam of processes, namely quality improvement through the Plan-Do-Study-Act cycle and medical education through Kolb's learning cycle and cognitive apprenticeship.

Patterns of health care utilization of gout patients in Hawai'i-high rates of emergency department utilization as compared to rheumatoid arthritis

Recent and comprehensive research of gout in the Pacific region and Hawai'i is significantly lacking. This study was conducted to improve the understanding of the healthcare utilization of gout patients within a single health care system in Hawai'i. The objective was to examine gout inpatient, outpatient and emergency department care within a single health care system in Hawai'i. This study was a retrospective chart review of patients, ≥ 18 years admitted to three Hawai'i Pacific Health facilities for a primary diagnosis of gout or rheumatoid arthritis (RA) from 2011 to 2017. Population data for the State of Hawai'i was used to calculate visit rates per 1,000 Hawai'i adults. Trend analysis was performed to compare changes over time. We studied gout health care utilization concurrently with RA to provide an internal comparison group for the healthcare utilization patterns of interest. Gout patients were primarily managed in the outpatient setting with high rates of emergency department visits. In contrast, RA patients were primarily managed in the outpatient setting, with low rates of emergency department visits. Both gout and RA patients had low rates of inpatient admissions. The cost of gout emergency department visits was approximately 3.4 times higher than gout outpatient visits. The rates for gout emergency department visits, outpatient visits, inpatients visits, and RA outpatient visits in 2017 were trending downward and significantly changed from 2011 (p <0.05). The rates for RA emergency department visits and inpatient visits were not significantly changed from 2011-2017. Gout care in Hawai'i remains suboptimal with higher rates of emergency department visits, as compared to RA. Because emergency department visits are associated with higher cost, efforts should be made to reduce these emergency department visits to improve the quality of care.

Association of Disease Definition, Comorbidity Burden, and Prognosis With Hip Fracture Probability Among Late-Life Women

IMPORTANCE

Advanced age is associated with lower use of drug treatment to prevent fractures, but concerns about comorbidities and prognosis increase the complexity of managing osteoporosis in this age group.

OBJECTIVE

To determine the association of disease definition, number of comorbidities, and prognosis with 5-year hip fracture probabilities among women who are 80 years and older.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study (4 US sites) included 1528 community-dwelling women identified as potential candidates for initiation of osteoporosis drug treatment.

MAIN OUTCOMES AND MEASURES

Women were contacted every 4 months to ascertain vital status and hip fracture. Five-year hip fracture probability was calculated accounting for competing mortality risk. Participants were classified into 2 distinct groups based on disease definition criteria proposed by the National Bone Health Alliance: with osteoporosis (n = 761) and without osteoporosis but at high fracture risk (n = 767). Comorbid conditions were assessed by self-report. Prognosis was estimated using a mortality prediction index. All analysis was performed between March 2018 and January 2019.

RESULTS

The study had 1528 participants, all of whom were women, with a mean (SD) age of 84.1 (3.4) years. During follow-up, 125 (8.0%) women experienced a hip fracture and 287 (18.8%) died before experiencing this event. Five-year mortality probability was 24.9% (95% CI, 21.8-28.1) among women with osteoporosis and 19.4% (95% CI, 16.6-22.3) among women without osteoporosis but at high fracture risk. In both groups, mortality probability similarly increased with more comorbidities and poorer prognosis. In contrast, 5-year hip fracture probability was 13.0% (95% CI, 10.7-15.5) among women with osteoporosis and 4.0% (95% CI, 2.8-5.6) among women without osteoporosis but at high fracture risk. The difference was most pronounced among women with more comorbidities or worse prognosis. For example, among women with 3 or more comorbid conditions, hip fracture probability was 18.1% (95% CI, 12.3-24.9) among women with osteoporosis vs 2.5% (95% CI, 1.3-4.2) among women without osteoporosis but at high fracture risk.

CONCLUSIONS AND RELEVANCE

Women 80 years and older who have osteoporosis, including those with more comorbidities or poorer prognosis, have a high 5-year probability of hip fracture despite accounting for competing mortality risk. In contrast, among women without osteoporosis but at high fracture risk, competing mortality risk far outweighs hip fracture probability, especially among those with more comorbidities or worse prognosis.

Intensive screening for osteoporosis in patients with hip fracture

Opportunities to evaluate, treat, and prevent future osteoporotic fractures are often being overlooked, especially in patients with a prior osteoporotic fracture. We find that an intensive outreach osteoporosis investigation strategy can help increase the number of patients investigated and treated for osteoporosis following a hip fracture.

PURPOSE

Patients experiencing a hip fracture are subject to an increased risk of subsequent fractures. This suggests an urgent need to develop strategies that will allow a higher number of patients with fragility hip fractures to be investigated and treated for osteoporosis. In accordance, we developed a secondary osteoporosis prevention program and evaluated the results of the program.

METHODS

In the study period, 1071 patients with a hip fracture were admitted to Hvidovre University Hospital. Eligible patients were offered an osteoporosis investigation program, which included a DXA-scan with vertebral fracture assessment and a medical consultation. The data retrieved from this program were registered and analyzed. The primary goal of the study was to describe the number of subjects, who completed the program, and to characterize the initiated osteoporosis treatment. Secondary outcomes evaluated were prevalence of DXA-verified osteoporosis, changes in T-score due to treatment, and 1-year mortality rate.

RESULTS

In total, 557 patients were offered participation of which 333 patients completed the full program. Among these, 159 patients had DXA-verified osteoporosis and 192 patients were started treatment. This resulted in a significant higher T-score at the lumbar spine and femoral neck compared with subjects not treated. Additionally, we report a 1-year mortality rate of 27.7% among all patients with hip fracture.

CONCLUSION

We report that an intensive outreach osteoporosis investigation program can help increase the number of hip fracture patients being tested and treated for osteoporosis. Further, the initiation of treatment can significantly increase the T-score.