Lack of Recognition and Treatment of Osteoporosis in Post‐Hip Fracture Patients

Background:

Approximately 300,000 hip fractures occur in the United States each year with 1‐year refracture and mortality rates as high as 12% and 25%, respectively. Bisphosphonate use after hip fracture reduces morbidity and mortality. Expert opinion suggests that a hip fracture indicates osteoporosis and warrants treatment. We endeavored to determine the rate of osteoporosis diagnosis and treatment after hip fracture at our academic medical center.

Methods:

We carried out a retrospective chart review of patients admitted with a hip fracture to either an orthopedic service with medicine consultation or a medicine service with an orthopedic consultation between July 2007 and May 2008. Primary outcomes included: measurement of a vitamin D level, completion of a DEXA scan, diagnosis of osteoporosis in the discharge summary, and treatment with vitamin D, calcium, or a bisphosphonate at discharge.

Results:

Forty patients were admitted during the study period. One patient was on a medicine service with orthopedic consultation, and 46 patients were on an orthopedic service with medicine consultation. Five of 40 patients (12.5%) carried a diagnosis of osteoporosis on admission and 5 and 2 patients (12.5% and 5%, respectively) were taking a bisphosphonate or vitamin D and calcium, respectively. During their hospital stay, 1 patient (2.5%) had a notation of osteoporosis in a medicine consultant's note, whereas none of the orthopedic notes documented this diagnosis. On discharge, 0 patients (0%) had vitamin D level checked, a DEXA scan ordered, or discharge summary diagnosis of osteoporosis recorded. Three patients (7.5%) were discharged with a bisphosphonate, whereas 5 (12.5%) were discharged with vitamin D and calcium.

Conclusions:

Osteoporosis is a morbid and mortal disease commonly manifested by hip fracture. Postfracture risk can be partially mitigated by early aggressive recognition and treatment of osteoporosis. Still, very few patients admitted with a hip fracture are evaluated, diagnosed, or treated for osteoporosis. The expansion of hospitalist involvement in the care of hip fracture patients offers a prime opportunity to reengineer systems to ensure these patients receive the appropriate postfracture care.

Author Disclosure:

J. Baker, none; J. Glasheen, none.