McMaster University, Hamilton, Ontario, Canada.
Bone Research and Education Center, Oakville, Ontario, Canada.
Arch Osteoporos. 2021 Jan 6;16(1):8. doi: 10.1007/s11657-020-00861-x.
Treatment rates for osteoporosis after a major osteoporotic fracture are unacceptably low. We evaluate the effectiveness of an ortho-geriatric team (OGT) in initiating pharmacologic therapy for osteoporosis post-hip fracture. The OGT was able to achieve a higher treatment rate for patients post-hip fracture in comparison to usual care provided by the primary care hospitalist. Potential reasons for delaying or not proceeding with drug therapy include patient concern regarding potential rare side effects of antiresorptive therapy including osteonecrosis of the jaw and atypical femoral fracture. These events however are rare, and in this study, only 3% of hip fractures were atypical femoral fractures.
Currently, a significant care gap for osteoporosis therapy exists post-hip fracture despite advances in pharmacologic therapy. We evaluate the effectiveness of the OGT at the Oakville Trafalgar Memorial Hospital (OTMH), Ontario, Canada, in reducing the care gap and initiating pharmacologic therapy in hip fracture patients prior to hospital discharge. We also evaluated the incidence of atypical femoral fracture (AFF) separately.
A retrospective chart review of patients 59 years and older with a hip fracture admitted to OTMH from January 1, 2016, to February 1, 2017, was conducted. The primary outcome was the proportion of hip fracture patients discharged from the hospital with appropriate treatment for their underlying osteoporosis. A sub-analysis was completed reporting the incidence of AFF among older adults.
A total of 197 patients with a hip fracture were identified, 134/197 (68%) patients were seen by the OGT, 98/134 (73%) of these patients were started on pharmacologic therapy prior to discharge, and 120/134 (89%) of patients seen by the OGT were on treatment within 3 months of discharge following assessment in the complex osteoporosis clinic. Sixty-three patients of the 197 (63/197) (32%) of the hip fracture patients were seen by a hospitalist, and treatment rates prior to discharge were 5%. Only 6/197 patients had experienced an AFF during the study period, and all patients with an atypical femoral fracture had been on long-term bisphosphonate therapy. All of the patients with an AFF had thigh or groin pain for several weeks to months prior to the development of the atypical femoral fracture, providing an opportunity to stop therapy and possibly prevent the development of a complete AFF.
The OGT was able to initiate anti-osteoporosis therapy in significantly more patients in comparison to usual care, and higher treatment rates are possible with an OGT.
目前，尽管抗骨质疏松药物治疗取得了进展，但髋部骨折后仍存在显著的治疗空白。我们评估了加拿大安大略省奥克维尔·特拉法尔加纪念医院（OTMH）的矫形老年病学团队（OGT）在减少治疗空白并在髋部骨折患者出院前启动药物治疗方面的效果。我们还单独评估了非典型股骨骨折（AFF）的发生率。
对 2016 年 1 月 1 日至 2017 年 2 月 1 日期间入住 OTMH 的年龄在 59 岁及以上的髋部骨折患者进行回顾性病历分析。主要结局是评估髋部骨折患者出院时接受适当治疗的比例，以治疗其潜在的骨质疏松症。完成了一项亚分析，报告了老年人中 AFF 的发生率。
共确定了 197 例髋部骨折患者，134/197（68%）例患者接受了 OGT 评估，其中 98/134（73%）例患者在出院前开始药物治疗，120/134（89%）例患者在复杂骨质疏松症门诊接受评估后 3 个月内开始治疗。197 例髋部骨折患者中有 63 例（63/197）（32%）患者由医院医生诊治，出院前的治疗率为 5%。研究期间仅发生了 6 例 AFF，所有 AFF 患者均长期接受双膦酸盐治疗。所有 AFF 患者在发生非典型股骨骨折前均有几周至几个月的大腿或腹股沟疼痛，有机会停止治疗并可能预防完全 AFF 的发生。
OGT 能够使明显更多的患者启动抗骨质疏松治疗，OGT 可实现更高的治疗率。
