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Li Q, Yang J, Tang Q, Feng Y, Pan M, Che M, Shi J, Zeng Y. Age-dependent gender differences in the diagnosis and treatment of osteoporosis during hospitalization in patients with fragility fractures. BMC Geriatr 2023; 23:728. [PMID: 37946131 PMCID: PMC10636910 DOI: 10.1186/s12877-023-04430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND There is a gender difference in the acceptance of osteoporosis diagnosis and treatment in patients after fragility fractures, but this difference is rarely assessed during hospitalization, and it is unclear whether these differences are age-dependent. This study aimed to evaluate the differences between male and female fragility fracture patients of different age groups who received the diagnosis and treatment of osteoporosis during hospitalization. METHODS 31,265 fragility fracture patients aged ≥ 50 years from the Fragility Fracture Management Database in a high-volume orthopedic hospital from December 2019 to February 2023 were included in this study. We compared the differences in the rates of men and women with fragility fracture who received the measurement of bone mineral density (BMD) and bone metabolism biochemical markers (BMBMs) and treatment with anti-osteoporosis medications (AOMs), and follow-up to the internal medicine clinic within 3 months after discharge, across all age groups and across different age stages (50-59, 60-69, 70-79, and ≥ 80 years). RESULTS The detection rates of female patients receiving BMD and BMBMs during hospitalization were 31.88% and 5.30%, respectively, compared with 22.23% and 2.69% for men. The rate of receiving any AOMs treatment was 44.63% for women and 31.60% for men. The follow-up rate of returning to the internal medicine clinic within 3 months after discharge was 9.79% for women compared to 3.00% for men. There was a significant difference between males compared to females (P < 0.0001). Analysis of patients by different age group revealed that differences in the diagnosis and treatment of osteoporosis were found only in patients under 80 years of age, while gender differences in the return to the internal medicine clinic for follow-up after discharge were present in all age groups. CONCLUSIONS Gender differences present in osteoporosis management in patients with fragility fracture during hospitalization, especially for patients under 80 years of age. This finding suggests that orthopedic surgeons neglect to manage osteoporosis in male patients with fragility fracture during hospitalization.
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Affiliation(s)
- Qingmei Li
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Jiancheng Yang
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Qinghua Tang
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Yan Feng
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Mingming Pan
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Maohong Che
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Jie Shi
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Yuhong Zeng
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China.
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Cheah MH, Lai PSM, Khor HM, Ratnasingam J, Chandrasekaran CSK, Singh S, Zakaria MIB, Ong T. Fragility fracture care gap at a tertiary teaching hospital in Malaysia. Arch Osteoporos 2023; 18:63. [PMID: 37148374 DOI: 10.1007/s11657-023-01256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Abstract
Fracture begets fracture, pharmacological treatment is needed to prevent secondary fractures. This study found that there was a fragility fracture care gap where both bone health investigations and treatment initiation rates were low. Strategies such as Fracture Liaison Service is needed to address the care gap. PURPOSE This study aimed to investigate the clinical burden and secondary fracture prevention of fragility fractures at a tertiary teaching hospital in Malaysia. METHODS Electronic medical records of all patients admitted with fragility fractures between 1 January 2017-31 December 2018 were reviewed. Patients < 50 years old, with non-fragility fractures, restricted access to medical records, transferred to another hospital or who passed away during admission were excluded. Descriptive statistics were used to summarise patients' characteristics, frequency of fragility fractures, and secondary fracture prevention details. Binomial logistic regression was performed to analyse predictive factors for post-fracture bone health assessments and treatment initiation. RESULTS 1030 patients [female (767/1030, 74.5%)] presented with 1071 fractures [hip fractures (378/1071, 35.3%)]. 170/993 (17.1%) patients were initiated on anti-osteoporosis medications (AOMs) and 148/984 (15.0%) had bone mineral density (BMD) performed within 1-year post-fracture. Less than half (42.4%) of the patients remained on treatment at 1-year post-fracture. Older patients [65-74 years old: odds ratio (OR) = 2.18, 95%CI 1.05-4.52, p = 0.04; ≥ 75 years: OR = 3.06, 95%CI 1.54-6.07, p < 0.01], hip fractures (OR = 1.95, 95%CI 1.23-3.11, p < 0.01), Chinese ethnicity (OR = 1.90, 95%CI 1.07-3.35, p = 0.03),previously diagnosed with osteoporosis (OR = 2.65, 95%CI:1.32-5.31, p < 0.01) and a BMD test performed (OR = 12.48, 95%CI 8.04-19.37, p < 0.01) were found to have higher AOM initiation. Patients with past diagnosis of osteoporosis (OR = 4.45, 95%CI 2.25-8.81, p < 0.01) and initiated on AOM (OR = 11.34, 95%CI 7.57-16.97, p < 0.01) had a higher likelihood to undergo BMD testing. CONCLUSION The AOM initiation and BMD testing rates were low. There is a need to address the fragility fracture care gap with strategies such as Fracture Liaison Service.
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Affiliation(s)
- Min Hui Cheah
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | - Simmrat Singh
- Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mohd Idzwan Bin Zakaria
- Academic Unit Trauma and Emergency, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Terence Ong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Seah YEC, Ho SF, Ang ASH, Bacud JP, Rosario BH. Nurse-Initiated Fall and Osteoporosis Screening for Older Adults in the Emergency Department. Cureus 2023; 15:e36001. [PMID: 37041925 PMCID: PMC10083134 DOI: 10.7759/cureus.36001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Background Many older adults presenting to the emergency department (ED) after a fall are discharged without adequate assessment of their fall risk. A nurse-initiated protocol was introduced for the early screening of older adults with injurious falls. We aimed to promote osteoporosis education and right-site them to appropriate outpatient resources in the community. Methodology In this study, we included ≥65-year-old adults who attended the ED with injurious falls or near falls between December 2019 and December 2020. An ED nurse trained in basic geriatric care performed the cognitive assessment and provided advice on diet, footwear, fall safety, calcium/vitamin D supplementation, and osteoporosis screening. Results A total of 70 (75.7% female) patients aged 65-93 years were included. In total, 34 (48.6%) were started on calcium/vitamin D supplements and 22 (31.4%) went on to receive outpatient bone mineral density scans. Only three patients reattended the ED for recurrent falls/fractures in the six-month follow-up period. Conclusions A nurse-initiated fall and osteoporosis screening protocol is a feasible model of care for targeted screening and education of older adults who present to the ED with injurious falls.
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Mahaisavariya C, Vanitcharoenkul E, Kitcharanant N, Chotiyarnwong P, Unnanuntana A. Exploring the osteoporosis treatment gap after fragility hip fracture at a Tertiary University Medical Center in Thailand. BMC Geriatr 2023; 23:70. [PMID: 36737708 PMCID: PMC9898992 DOI: 10.1186/s12877-023-03778-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND (1) To evaluate the prescription rate of anti-osteoporosis medication, and (2) to identify factors associated with patients not receiving anti-osteoporosis medication or, when prescribed, not persisting with medication 1 year after hip fracture treatment. METHODS We retrospectively reviewed the medical records of all fragility hip fracture patients admitted to the orthopedic unit of the Faculty of Medicine Siriraj Hospital, Mahidol University, between July 1, 2016, and December 31, 2019. We identified patients who did not receive anti-osteoporosis medication both 6 months and 1 year after fracture treatment. Patients who did not receive the medication 1 year after their treatment were enrolled and interviewed using a no-treatment questionnaire. RESULTS In total, 530 patients with fragility hip fractures were eligible (mean age, 79.0 years), and most (74.5%) were women. Only 148 patients (31.6%) received anti-osteoporosis medication 1 year after hip fracture. Logistic regression analysis identified predictors for not receiving the medication: male sex (OR 1.8; 95% CI 1.1-3.0), Charlson comorbidity index score ≥ 5 (OR 1.5; 95% CI 1.0-2.3), and secondary school education or below (OR 2.0; 95% CI 1.2-3.3). The main reason for not receiving the medication was that healthcare providers neither discussed nor initiated pharmacological treatment for osteoporosis (48.2%). When the medication was prescribed, non-persistence primarily stemmed from transportation difficulties that resulted in patients missing follow-ups (50.0%). CONCLUSIONS Improved physician attitudes toward anti-osteoporosis medications might enhance the treatment rate. Developing a follow-up team and facilitating access to medications (eg, courier delivery to patients) would promote therapy compliance. TRIAL REGISTRATIONS The protocol for the first phase and second phase was approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. Si 180/2021) and for the second phase, patients-informed consent forms used in the cross-sectional component were approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. Si 180/2021). The research was registered with the Thai Clinical Trials Registry (TCTR number: 20210824002). The study was conducted in accordance with the Declaration of Helsinki. Each patient (or a relative/caregiver) provided informed consent in writing or by telephone to participate in this second study phase.
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Affiliation(s)
- Chantas Mahaisavariya
- grid.10223.320000 0004 1937 0490Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekasame Vanitcharoenkul
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Nitchanant Kitcharanant
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pojchong Chotiyarnwong
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Tarantino U, Cariati I, Greggi C, Iundusi R, Gasbarra E, Iolascon G, Kurth A, Akesson KE, Bouxsein M, Tranquilli Leali P, Civinini R, Falez F, Brandi ML. Gaps and alternative surgical and non-surgical approaches in the bone fragility management: an updated review. Osteoporos Int 2022; 33:2467-2478. [PMID: 35851407 DOI: 10.1007/s00198-022-06482-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
Osteoporotic fractures are one of the major problems facing healthcare systems worldwide. Undoubtedly, fragility fractures of the hip represent a far greater burden in terms of morbidity, mortality, and healthcare costs than other fracture sites. However, despite the significant impact on the health and quality of life of older adults, there is a general lack of awareness of osteoporosis, which results in suboptimal care. In fact, most high-risk individuals are never identified and do not receive adequate treatment, leading to further fragility fractures and worsening health status. Furthermore, considering the substantial treatment gap and the proven cost-effectiveness of fracture prevention programs such as Fracture Liaison Services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are adequately assessed and treated. Based on this evidence, the aim of our review was to (i) provide an overview and comparison of the burden and management of fragility fractures, highlighting the main gaps, and (ii) highlight the importance of using alternative approaches, both surgical and non-surgical, with the aim of implementing early prevention of osteoporotic fractures and improving the management of osteoporotic patients at imminent and/or very high risk of fracture.
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Affiliation(s)
- Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133, Rome, Italy
| | - Ida Cariati
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
- PhD in Medical-Surgical Biotechnologies and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Chiara Greggi
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
- PhD in Medical-Surgical Biotechnologies and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Riccardo Iundusi
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133, Rome, Italy
| | - Elena Gasbarra
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Andreas Kurth
- Department of Orthopaedic and Trauma Surgery, Community Clinics Middle Rhine, Campus Kemperhof, Koblenz, Germany
| | - Kristina E Akesson
- Department of Clinical Sciences Malmö, Lund University and Department of Orthopedics, Skane University Hospital, Malmö, Sweden
| | - Mary Bouxsein
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Harvard Medical School, BIDMC, Boston, MA, USA
| | | | - Roberto Civinini
- Department of Surgical Science, University of Florence, Florence, Italy
| | - Francesco Falez
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Rome, Italy
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Wen AFYH, Chong BYK, Joseph LV, Bee JKS, Sen HT, Mamun K. Challenges in osteoporosis treatment initiation in geriatric patients admitted under the hip-fracture pathway. Arch Osteoporos 2022; 17:136. [PMID: 36271963 DOI: 10.1007/s11657-022-01179-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Abstract
Osteoporosis is often untreated especially in older people. This study found a low prescribing rate of osteoporosis treatment medication of 22.4% in older people admitted under the hip-fracture pathway. Factors associated with greater odds of being prescribed osteoporosis medications are categorized into patient-related, physician-related and system-related factors. INTRODUCTION Osteoporosis represents a growing healthcare problem which is often overlooked by healthcare providers and untreated especially in older people. This study aims to assess the rate of osteoporosis treatment initiation and to investigate underlying physician and system-related barriers in geriatric patients admitted for hip fracture. METHODS A retrospective study was conducted on patients aged 60 years and older, admitted under the hip-fracture pathway from January 2019 to December 2019. Data collected included demographics, co-morbid conditions and laboratory data. Clinical charts were reviewed for whether bone mineral density (BMD) scan has been ordered, plans for bone health were made and reflected in the discharge summary, and if appropriate memos were written. The primary outcome was the prescription of osteoporosis treatment medications. Prescription lists were also reviewed for prescribing patterns of calcium and vitamin D. RESULTS A total of 375 patients older than 60 years old were identified. 281 patients who fit the inclusion and exclusion criteria with complete data were further analysed. Within 1 year of hip fracture admission, 63 (22.4%) of them were prescribed with osteoporosis treatment. Multivariate logistic regression identified milder stage of CKD (p = 0.038, OR = 0.617, 95% CI 0.392-0.973) and BMD scan performed (p < 0.001, OR = 6.515, 95% CI 3.180-13.348) as independent factors associated with the prescription of osteoporosis treatment within 1 year of hip fracture admission. CONCLUSION The rate of osteoporosis treatment initiation post-hip fracture is low. Systematic solutions will need to be established to ensure that osteoporosis treatment is addressed prior to discharge.
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Affiliation(s)
| | | | | | - Joyce Koh Suang Bee
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Howe Tet Sen
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kaysar Mamun
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
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Mitchell PJ, Ang SB, Mercado-Asis LB, Rey-Matias R, Chen WS, Flicker L, Leung E, Choon D, Chandrasekaran SK, Close JCT, Seymour H, Cooper C, Halbout P, Blank RD, Zhao Y, Lim JY, Tabu I, Tian M, Unnanuntana A, Wong RMY, Yamamoto N, Chan DC, Lee JK. Quality improvement initiatives in the care and prevention of fragility fractures in the Asia Pacific region. Arch Osteoporos 2022; 17:115. [PMID: 35987919 PMCID: PMC9392505 DOI: 10.1007/s11657-022-01153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/01/2022] [Indexed: 02/03/2023]
Abstract
This narrative review summarises ongoing challenges and progress in the care and prevention of fragility fractures across the Asia Pacific region since mid-2019. The approaches taken could inform development of national bone health improvement Road Maps to be implemented at scale during the United Nations 'Decade of Healthy Ageing'. PURPOSE This narrative review summarises recent studies that characterise the burden of fragility fractures, current care gaps and quality improvement initiatives intended to improve the care and prevention of fragility fractures across the Asia Pacific region. METHODS The review focuses on published studies, reports and quality improvement initiatives undertaken during the period July 2019 to May 2022. RESULTS Epidemiological studies conducted in countries and regions throughout Asia Pacific highlight the current and projected increasing burden of fragility fractures. Recent studies and reports document a persistent and pervasive post-fracture care gap among people who have sustained fragility fractures. Global initiatives developed by the Fragility Fracture Network and International Osteoporosis Foundation have gained significant momentum in the Asia Pacific region, despite the disruption caused by the COVID-pandemic. The Asia Pacific Fragility Fracture Alliance has developed educational resources including a Hip Fracture Registry Toolbox and a Primary Care Physician Education Toolkit. The Asia Pacific Osteoporosis and Fragility Fractures Society-a new section of the Asia Pacific Orthopaedic Association-is working to engage orthopaedic surgeons across the region in the care and prevention of fragility fractures. The Asia Pacific Consortium on Osteoporosis developed a framework to support national clinical guidelines development groups. Considerable activity at the national level is evident in many countries across the region. CONCLUSION Development and implementation of national Road Maps informed by the findings of this review are urgently required to respond to the epidemiological emergency posed by fragility fractures during the United Nations 'Decade of Healthy Ageing'.
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Affiliation(s)
- Paul James Mitchell
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Synthesis Medical NZ Limited, Pukekohe, Auckland, New Zealand
| | - Seng Bin Ang
- Asian Federation of Osteoporosis Societies, c/o KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
- Menopause Unit and Family Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Leilani Basa Mercado-Asis
- Asian Federation of Osteoporosis Societies, c/o KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
- Department of Endocrinology, Metabolism and Diabetes, Public Health, University of the Philippines, Manila, Philippines
| | - Reynaldo Rey-Matias
- Asia-Oceanian Society of Physical and Rehabilitation Medicine, Kowloon, Hong Kong SAR, China
- Department of Physical and Rehabilitation Medicine, St Luke's Medical Center, Quezon City, Philippines
- College of Medicine, Philippine Academy of Rehabilitation Medicine, Manila, Philippines
| | - Wen-Shiang Chen
- Asia-Oceanian Society of Physical and Rehabilitation Medicine, Kowloon, Hong Kong SAR, China
- Department of Physical Medicine and Rehabilitation (University Hospital), National Taiwan University, Taipei, Taiwan
| | - Leon Flicker
- Asia Pacific Geriatric Network, Virtual Network, Perth, Australia
- Internal Medicine, University of Western Australia, Perth, WA, Australia
| | - Edward Leung
- Asia Pacific Geriatric Network, Virtual Network, Perth, Australia
- Geriatric Medicine Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong SAR, China
| | - David Choon
- Asia Pacific Orthopaedic Association, Bukit Jalil, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Wilayah Persekutuan, Kuala LumpurKuala Lumpur, Malaysia
| | - Sankara Kumar Chandrasekaran
- Asia Pacific Orthopaedic Association, Bukit Jalil, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Wilayah Persekutuan, Kuala LumpurKuala Lumpur, Malaysia
| | - Jacqueline Clare Therese Close
- Fragility Fracture Network, c/o MCI Schweiz AG, Zurich, Switzerland
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Hannah Seymour
- Fragility Fracture Network, c/o MCI Schweiz AG, Zurich, Switzerland
- Department of Geriatrics and Aged Care, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Cyrus Cooper
- International Osteoporosis Foundation, Nyons, Switzerland
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | - Robert Daniel Blank
- International Society for Clinical Densitometry, Middletown, CT, USA
- Osteoporosis and Translational Research Laboratory, Garvan Institute of Medical Research, Sydney, Australia
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Yanling Zhao
- International Society for Clinical Densitometry, Middletown, CT, USA
- Beijing United Family Hospital (Department of Obstetrics and Gynecology), Beijing, China
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Irewin Tabu
- Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines
- Institute On Aging, National Institutes of Health, UP Manila, Manila, Philippines
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ronald Man Yeung Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Noriaki Yamamoto
- Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Changde St, Taipei, Taiwan.
| | - Joon Kiong Lee
- Department of Orthopaedics, Beacon Hospital, 1, Jalan 215, Section 51, Off Jalan Templer, 46050, Petaling Jaya, Selangor, Malaysia.
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González-Quevedo D, Pérez-Del-Río V, Moriel-Garceso D, Fernández-Arroyabe N, García-Meléndez G, Montañez-Ruiz M, Bravo-Bardají M, García-de-Quevedo D, Tamimi I. A 2-year follow-up of a novel Fracture Liaison Service: can we reduce the mortality in elderly hip fracture patients? A prospective cohort study. Osteoporos Int 2022; 33:1695-1702. [PMID: 35357521 PMCID: PMC8967686 DOI: 10.1007/s00198-022-06298-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
Abstract
UNLABELLED Osteoporosis is an underdiagnosed disease that results in bone fragility and risk of fractures. Fracture Liaison Service (FLS) is a secondary prevention model which identifies patients at risk for fragility fractures. The introduction of a FLS protocol showed an increase of anti-osteoporotic drug prescription and significant reduction of all-cause mortality. INTRODUCTION Hip fractures are the most severe osteoporotic fracture due to their associated disability and elevated risk of mortality. FLS programs have enhanced the management of osteoporosis-related fractures. Our objective is to analyze the effect of the FLS model over survival and 2-year mortality rate following a hip fracture. METHODS We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture during 3 consecutive years, before and after the implementation of the FLS in our center (i.e., between January 2016 and December 2018). Patients' information was withdrawn from our local computerized database. Patients were followed for 2 years after the hip fracture. Mortality and re-fracture rates were compared between the two groups using a multivariate Cox proportional hazard model. RESULTS A total of 1101 patients were included in this study (i.e., 357 before FLS implementation and 744 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (583 (78.4%) vs 44 (12.3%); p < 0.01). There was an increase of adherence to treatment after FLS implementation (227 (38.9%) vs 12 (3.3%); p = 0.03). A total of 222 (29.8%) patients after FLS implementation and 114 (31.9%) individuals before FLS implementation (p = 0.44) died during the follow-up period. A second fracture occurred in 49 (6.6%) patients after FLS implementation and in 26 (7.3%) individuals before FLS implementation (p = 0.65). Patients who were treated with anti-osteoporotic drugs after the implementation of the FLS protocol had a lower all-cause 1-year and 2-year mortality compared with patients managed before the implementation of the FLS protocol (adjusted hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.59-0.96; HR 0.87, 95% CI 0.69-1.09, respectively). CONCLUSIONS The implementation of a FLS protocol was associated with an increase of anti-osteoporotic treatment, higher adherence, and greater survival in elderly hip fracture patients. There was a significant reduction of all-cause mortality in the FLS patients treated with anti-osteoporotic. However, the application of the FLS did not affect the risk of suffering a second fragility fracture.
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Affiliation(s)
- D González-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain.
- School of Medicine, University of Málaga, Málaga, Spain.
| | - V Pérez-Del-Río
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - D Moriel-Garceso
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - N Fernández-Arroyabe
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - G García-Meléndez
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - M Montañez-Ruiz
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - M Bravo-Bardají
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - D García-de-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - I Tamimi
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
- School of Medicine, University of Málaga, Málaga, Spain
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9
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Tan LF, Ying SM, Teng J, Premkumar A, Tan ATH, Seetharaman S. The Impact of Frailty, Falls and Cognition on Osteoporosis Management in the Oldest Old. Calcif Tissue Int 2022; 111:145-151. [PMID: 35428924 DOI: 10.1007/s00223-022-00978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Data and clinical guidelines on the management of osteoporosis in nonagenarians are lacking. The aim of this study was to assess the characteristics of osteoporosis management and identify any gaps or trends in a cohort of nonagenarians who were newly diagnosed with osteoporosis during an inpatient admission. A retrospective analysis of nonagenarians admitted to the medicine department of a tertiary hospital who were newly diagnosed with osteoporosis based on extracted ICD-10 codes. Baseline demographics, frailty based on the clinical frailty scale, comorbidities, initiation, compliance and adverse effects on osteoporosis medication were analysed. Mean age of the study group was 93.0 ± 2.5 years. There was a high prevalence of frailty (71.7%), cognitive impairment (34.2%) and recurrent falls (30.0%). 82.5% were started on osteoporosis treatment with denosumab (43.4%) being the most prescribed, followed by alendronate (41.4%). Cognitive impairment and male gender were associated with less likelihood of being on osteoporosis treatment on multivariate analysis. Having a previous fracture was associated with a higher likelihood of being on osteoporosis treatment. There was a discontinuation rate of 49.5% with a mean time to discontinuation of 26.3 ± 22.9 months. There was a high rate of osteoporosis treatment in nonagenarians with osteoporosis. The presence of previous fractures was associated with initiation of osteoporosis medications, whereas frailty and falls had no impact on treatment decisions. Cognitive impairment and males were associated with a lower rate of initiation of osteoporosis medication.
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Affiliation(s)
- Li Feng Tan
- Division of Healthy Ageing, Alexandra Hospital, Blk 20A 378 Alexandra Road, Singapore, 159964, Singapore.
| | - Sim Meng Ying
- Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Jeremy Teng
- Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Arthi Premkumar
- Division of Healthy Ageing, Alexandra Hospital, Blk 20A 378 Alexandra Road, Singapore, 159964, Singapore
| | - Andre Teck Huat Tan
- Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Fast and Chronic Programme, Alexandra Hospital, 378 Alexandra Road, Singapore, 159964, Singapore
| | - Santhosh Seetharaman
- Division of Healthy Ageing, Alexandra Hospital, Blk 20A 378 Alexandra Road, Singapore, 159964, Singapore
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10
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Aypak C, Bircan MA, Özdemir A. Anti-osteoporotic Drug Utilization Rates for Secondary Prevention Among Patients with Osteoporotic Fractures. Rambam Maimonides Med J 2022; 13:RMMJ.10473. [PMID: 35701156 PMCID: PMC9345764 DOI: 10.5041/rmmj.10473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Anti-osteoporotic drugs (AOD) are essential for secondary prevention of osteoporotic fracture (OF) in patients with established osteoporosis. However, data about AOD utilization rates are scarce among patients with OF. This study was therefore aimed at determining the AOD utilization rates among those particularly vulnerable patients. MATERIALS AND METHODS This cross-sectional study followed the medical records of patients with OF starting from their first OF diagnosis date. Each patient's preventive osteoporosis treatments (vitamin D, calcium+vitamin D) and AOD utilization rate were recorded for a 12-month period following OF diagnosis. RESULTS A total of 210 patients (168 females, mean age: 67.8±11.9 years; 42 males, mean age 62.4±16.1 years) were enrolled in the study. Of these, 65.7% (n=138) did not use any medication for primary protection against osteoporosis before OF diagnosis. The ratio of patients not using any type of medication for secondary prevention after OF increased from 26.5% to 51% during a 12-month period. In addition, by one year following diagnosis, AOD usage rate had decreased from 62.3% to 41.3%. CONCLUSION The AOD usage rates for secondary prevention of OF were insufficient, and cessation rates were high. Identification of factors associated with decreased AOD utility rates will provide important information for guiding patient follow-up in order to reduce the occurrence of OF.
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Affiliation(s)
- Cenk Aypak
- To whom correspondence should be addressed. E-mail:
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11
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Zhao H, Zhang M, Zhen Y, Tang Y. The Relationships Between Glycated Hemoglobin and Bone Turnover Markers in Patients with Type 2 Diabetes but No Diabetic Nephropathy. Int J Gen Med 2022; 15:5591-5598. [PMID: 35712058 PMCID: PMC9192782 DOI: 10.2147/ijgm.s366725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/26/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate the relationships between glycated hemoglobin (HbA1c) level and bone turnover markers (BTMs) in patients with type 2 diabetes mellitus (T2DM) but no diabetic nephropathy. Patients and Methods Patients with T2DM were recruited at Hebei General Hospital in China. The participants were allocated to three groups: an HbA1c <7% group, an HbA1c 7%–9% group, and an HbA1c ≥9% group. Their general characteristics, biochemical indices, and BTM concentrations were recorded. Results The ages of the HbA1c <7% group and the HbA1c 7%–9% group were significantly higher than that of the HbA1c ≥9% group (P<0.05). The prevalence of a history of hypertension in the HbA1c 7%–9% group was significantly higher than that in the HbA1c ≥9% group. The circulating low-density lipoprotein-cholesterol concentration in the HbA1c ≥9% group and the apolipoprotein B concentration in the HbA1c 7%–9% group were significantly higher than those in the HbA1c <7% group (P<0.05). Compared with that in the HbA1c <7% group, the circulating 25-hydroxyvitamin D (25OHD) concentration was significantly lower in the HbA1c ≥9% group (P<0.05). Additionally, the circulating 25OHD and osteocalcin (OC) concentrations negatively correlated with HbA1c (P<0.05). Conclusion An increase in HbA1c is associated with gradual decreases in the circulating concentrations of 25OHD and OC.
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Affiliation(s)
- Hang Zhao
- Endocrinology Department, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Miaomiao Zhang
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, 050017, People's Republic of China
| | - Yunfeng Zhen
- Endocrinology Department, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yong Tang
- Endocrinology Department, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People's Republic of China
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12
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Chandran M, Hao Y, Kwee AK, Cheen MHH, Chin YA, Ng VYT. Adherence to dosing schedule of denosumab therapy for osteoporosis during COVID-19 lockdown: an electronic medical record and pharmacy claims database study from Asia. Osteoporos Int 2022; 33:251-261. [PMID: 34417842 PMCID: PMC8379568 DOI: 10.1007/s00198-021-06085-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022]
Abstract
UNLABELLED COVID-19 lockdowns have impacted management of chronic diseases such as osteoporosis. Adherence to the 6-monthly dosing schedule of denosumab, the parenteral anti-osteoporosis medication most often used in Singapore, was significantly reduced during the lockdown period compared to that during pre-COVID-19 times. Patients managed by endocrinologists were more likely to be adherent. PURPOSE No study thus far has quantified actual adherence rates to anti-osteoporosis therapy with denosumab during COVID-19 or explored factors associated with it. We aimed to estimate the adherence rates to denosumab in Singaporean men and women during COVID-19 lockdown and to compare it with those during the pre-COVID-19 period. METHOD We conducted this retrospective, electronic medical records, and pharmacy claims database study at Singapore General Hospital, the largest hospital in the country. Patients initiated on subcutaneous denosumab between August 2019 and December 2019 and were thus scheduled to receive the second dose during the COVID-19 first-wave period from February 2020 to June 2020 (lockdown group) were analyzed, as were patients initiated anytime on denosumab between September 2011 and December 2018 (pre-COVID-19 group). Data extracted from the hospital's electronic prescription platform and patients' pharmacy purchase records were matched. Adherence was defined as being punctual (with an allowable delay of up to 4 weeks) with the second dose scheduled 6 months from the 1st dose. A sensitivity analysis with an allowable delay up to 8 weeks was also performed. We compared the adherence rates between the two periods and explored factors associated with adherence. RESULTS A total of 768 and 1458 patients respectively during the lockdown and pre-COVID-19 periods were analyzed. The mean adherence rate during lockdown was 63.9%. The odds of being adherent during lockdown were higher if patients were managed by endocrinologists as opposed to those by other specialists [OR 2.516 (95% CI: 1.836-3.448); p < 0.001]. Adherence rates during the pre-COVID-19 period was 75.4%. Overall, the odds of being adherent to denosumab was significantly lower during lockdown than that during the pre-COVID-19 period [OR 0.525 (95% CI 0.430-0.640); p < 0.001], and odds of being adherent were higher if patients were managed by endocrinologists than if they were managed by other specialists (OR 1.765 (95% CI: 1.444-2.158; p < 0.001). CONCLUSION Adherence to denosumab was significantly lower during COVID-19 lockdown than the pre-COVID-19 period. The odds of being adherent were higher in patients managed by endocrinologists. Whether healthcare providers from certain specialties spend more time counselling and educating patients about the importance of adherence to osteoporosis medications needs to be explored further.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
| | - Ying Hao
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Singapore
| | - Ann Kerwen Kwee
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | | | - Yun Ann Chin
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
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13
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Tan HC, Seng JJB, Low LL. Osteoporosis awareness among patients in Singapore (OASIS)-a community hospital perspective. Arch Osteoporos 2021; 16:151. [PMID: 34623530 PMCID: PMC8497186 DOI: 10.1007/s11657-021-01012-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/26/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study examines factors associated with osteoporosis awareness and knowledge using Osteoporosis Prevention and Awareness Tool (OPAAT). Of 410 patients, majority of patients had a OPAAT score < 24 (n = 362, 88.3%). Lower education level (odds ratio (OR) (primary education): 3.63; OR (no formal education): 111.5; p < 0.001) and diabetic patients (OR: 1.67; p = 0.003) were associated with lower OPAAT scores. INTRODUCTION Lack of osteoporosis awareness forms a critical barrier to osteoporosis care and has been linked with increased institutionalization, healthcare expenditures, and decreased quality of life. This study aims to identify factors associated with osteoporosis awareness and knowledge among female Singaporeans. METHODOLOGY A cross-sectional study was conducted among adult female patients (aged 40 to 90 years old) who were admitted into Outram Community Hospital from April to October 2020. Osteoporosis awareness and knowledge were assessed using interviewer-administered Osteoporosis Prevention and Awareness Tool (OPAAT). High knowledge was defined as a OPAAT score ≥ 24. Multivariate logistical regression analyses were used to identify predictors of low OPAAT scores. RESULTS Of 410 patients recruited, their mean age was 71.9 ± 9.5 years old and majority of patients had a OPAAT score < 24 (n = 362, 88.3%). Patients with lower OPAAT scores tended to be older (72.5 ± 9.2 vs 67.5 ± 10.1, p < 0.001), attained lower education level (p < 0.001), and were more likely to live in public housing (92.5% vs 81.5%, p = 0.009). The prevalence of diabetes mellitus was higher in patients with low OPAAT scores (39.2% vs 18.8%, p = 0.006). After adjustment for covariates, lower education level (odds ratio (OR) (primary education): 3.63; OR (no formal education): 11.5; p < 0.05) and patients with diabetes mellitus (OR: 1.67; p = 0.03) were associated with lower OPAAT knowledge scores. CONCLUSION Elderly female patients in community hospital have inadequate osteoporosis awareness despite being at risk of fractures. There is a need to address the knowledge gap in osteoporosis, especially among diabetic patients or patients with lower education.
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Affiliation(s)
- Huey Chieng Tan
- grid.453420.40000 0004 0469 9402Outram Community Hospital, SingHealth Community Hospitals, 10 Hospital Boulevard, Singapore, 168582 Singapore
| | - Jun Jie Benjamin Seng
- grid.466910.c0000 0004 0451 6215MOH Holdings (Singapore) Private Limited, 1 Maritime Square, Singapore, 099253 Singapore
| | - Lian Leng Low
- grid.453420.40000 0004 0469 9402Outram Community Hospital, SingHealth Community Hospitals, 10 Hospital Boulevard, Singapore, 168582 Singapore ,grid.163555.10000 0000 9486 5048Department of Family Medicine and Continuing Care, Singapore General Hospital, Outram Rd, Singapore, 169608 Singapore ,grid.4280.e0000 0001 2180 6431SingHealth Duke-NUS Family Medicine Academic Clinical Program, Outram Rd, Singapore, 169608 Singapore ,grid.453420.40000 0004 0469 9402SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608 Singapore
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