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Treatment of osteoporosis in postmenopausal hip fracture patients after geriatric rehabilitation

Changes over the last decade

Osteoporosetherapie nach geriatrischer Rehabilitation bei postmenopausalen Frauen mit hüftnahen Frakturen

Veränderungen in den letzten 10 Jahren

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Abstract

Background

Osteoporotic hip fractures are a major cause of morbidity and mortality in postmenopausal women, and their impacts on society are substantial. Although adequate osteoporotic treatment reduces the risk of subsequent fractures and also mortality, only a minor proportion of the patients receives sufficient therapy.

Objectives

The goal of the present study was to evaluate osteoporosis treatment in two different cohorts and to describe the changes after the implementation of a Geriatric Facture Center (GFC) in cooperation with a level 1 trauma center.

Study design

A retrospective, single-center cross sectional study design was used.

Methods

A total of 455 patients (70 years and older) were included at our department of geriatric medicine. The patients were split into two groups. The usual care (UC) group consisted of 327 patients admitted to our department from 2001–2004. The GFC group included 128 patients admitted from 2009–2010. In addition to recording osteoporosis therapy, we collected demographic data, comorbidities, and different functional parameters of the patients. The data were collected retrospectively using medical records. SPSS 18.0 was used for statistical analysis.

Results

Of the patients, 43% in the GFC group received a specific antiresorptive or anabolic treatment (SAAT). Basic treatment with calcium and vitamin D3 was prescribed in 88% of the patients. The diagnosis “osteoporosis” was found in 73.4% of the discharge letters. In the UC group, the percentage of patients with a SAAT was 14.7%, calcium and vitamin D3 was prescribed in 30%, and the diagnosis was documented in 24.5%. All these differences are statistically significant (p < 0.0001). In the GFC group, better functional status and cognition were significantly associated with a higher rate of a prescribed SAAT, whereas age and comorbidities showed a negative association.

Conclusion

Our results show that the management of osteoporosis in postmenopausal hip fracture patients has significantly improved over the last decade. From our point of view, the main impact on this development is due to the implementation of a GFC with corresponding guidelines and treatment steps. In addition to structural changes, the improved evidence for osteoporosis treatment, especially of geriatric patients, has a positive influence on osteoporosis therapy.

Zusammenfassung

Hintergrund

Osteoporotische Frakturen stellen sowohl für die Betroffenen als auch für das Gesundheits- und Sozialsystem eine große Belastung dar. Bei älteren Frauen treten typischerweise hüftnahe Frakturen auf. Obwohl durch eine adäquate osteoporotische Therapie die Frakturrate und auch die Mortalität signifikant reduziert werden können, erhält nur eine Minderheit der Patientinnen die erforderliche Medikation.

Zielsetzung

Ziel der vorliegenden Studie war es, die Versorgung der Osteoporosetherapie in zwei Kohorten zu untersuchen sowie die Veränderungen nach Implementierung eines Geriatric Fracture Centers (GFC) an einem Traumazentrum darzustellen.

Studiendesign

Als Design wurde eine retrospektive Single-Center-Querschnittsuntersuchung benutzt.

Methode

Insgesamt konnten 455 Patientinnen (70 Jahre und älter) der Abteilung für Innere Medizin und Akutgeriatrie in die Studie eingeschlossen werden, die in zwei Gruppen aufgeteilt wurden. Patientinnen aus den Jahren 2001 bis 2004 wurden wie üblich behandelt und bildeten die Vergleichsgruppe (n=327). Die anderen 128 Patientinnen wurden 2009 bis 2011 interdisziplinär im Rahmen des GFC betreut. Neben der Osteoporosetherapie wurden Komorbiditäten sowie funktionelle Parameter als mögliche Einflussfaktoren miterfasst. Die Datenerhebung erfolgte retrospektiv anhand der Krankenakten. Die Auswertung erfolgte mittels SPSS 18.0.

Ergebnisse

In der Gruppe der GFC-Patienten erhielten 43% eine spezifische anitresorptive oder anabole Therapie. Die Basistherapie mit Kalzium und Vitamin D3 wurde in 88% der Fälle verordnet, die Diagnose „Osteoporose“ fand sich in 73,4% der Entlassungsbriefe. In der Vergleichsgruppe lag der Prozentsatz der Patienten mit einer spezifischen Therapie bei 14,7%, mit Kalzium und Vitamin D3 bei 30%, die Diagnose wurde in 24,5% angeführt. Alle Veränderungen sind hochsignifikant (p<0,0001). In der Gruppe der GFC-Patienten war ein besserer Funktionsstatus signifikant mit der Verordnung einer Basistherapie assoziiert; Alter, Komorbiditäten, kognitives Defizit waren signifikant negativ assoziiert; keinen Einfluss hatte die Polypharmazie.

Schlussfolgerung

Unsere Ergebnisse zeigen, dass es in den letzten 10 Jahren zu einer hochsignifikanten Verbesserung in der Versorgung der Patientinnen nach hüftnahen Frakturen gekommen ist. Einen wesentlichen Anteil an dieser Entwicklung dürfte die Etablierung eines GFC mit entsprechenden Leitlinien und Behandlungsschritten sein. Neben den strukturellen Änderungen hat sicher die verbesserte Evidenz für die Behandlung, insbesondere der geriatrischen Patienten, einen positiven Einfluss auf die Osteoporosetherapie.

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The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Abt. für Innere Medizin und Akutgeriatrie, Landeskrankenhaus Hochzirl, Hochzirl 1, 6170, Zirl, Österreich

    M. Gosch MAS, B. Joosten-Gstrein, U. Benvenuti-Falger & M. Lechleitner

  2. Universitätsklinik für Unfallchirurgie, Innsbruck, Innsbruck, Österreich

    T. Roth, C. Kammerlander & M. Blauth

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  1. M. Gosch MAS
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  2. T. Roth
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  3. C. Kammerlander
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  4. B. Joosten-Gstrein
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  5. U. Benvenuti-Falger
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  6. M. Blauth
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  7. M. Lechleitner
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Correspondence to M. Gosch MAS.

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Gosch, M., Roth, T., Kammerlander, C. et al. Treatment of osteoporosis in postmenopausal hip fracture patients after geriatric rehabilitation. Z Gerontol Geriat 44, 381–386 (2011). https://doi.org/10.1007/s00391-011-0254-6

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  • DOI: https://doi.org/10.1007/s00391-011-0254-6

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