Background One in four women and one in eight men over 50 years of age will suffer from osteoporosis. The lifetime prevalence of hip fracture is 18% for women, 6% for men. Mortality within a year of hip fracture is 6–44%. Morbidity is also significant, with many not returning to their premorbid level of function. Proven efficacious pharmacologic therapies are available to treat osteoporosis.
Objectives The objective of this study was to evaluate the diagnosis and treatment of osteoporosis in seniors after hip fracture both in the acute care hospital and in the rehabilitation facility, and to see if they differ.
Methods A retrospective chart review on consecutive hip fracture patients (over 65 yrs) admitted to an acute tertiary care referral hospital was carried out. Osteoporosis diagnosis and treatment was recorded. Additional data was collected on osteoporosis investigations including bone densitometry. The patients were then followed up in the rehabilitation facility and the same data collected. The results from the two groups were then compared.
Results Data was collected on 311 patients in acute care. Average age was 86 years, average length of stay in acute care was 11 days. 18 died and 41 either went straight home or to long term care. Data was unavailable in 26 patients. Therefore 226 were followed up in the rehabilitation facility. Osteoporosis was diagnosed on admission to: acute care in 11.9%; rehabilitation in 9.7% and on discharge from: acute care in 15.4%; and from rehabilitation in 11.2%. Osteoporosis was treated (any treatment) in acute care hospitals in 13% on admission and 9.7% on discharge and in rehabilitation facilities 12.8% and 10.2% respectively. In the majority of cases the treatment was calcium alone, specific osteoporotic drugs were used in <4% in both groups. There was no statistically significant differences between the groups, apart from the use of Vitamin D which was significantly less (p < 0.05) in the rehabilitation group compared to the acute care group.
Conclusion Rehabilitation facilities are no better than acute care hospitals at diagnosing and pharmacologically treating osteoporosis in seniors after hip fracture. The rate of treatment in both groups is unacceptably low. In spite of their more holistic and multidisciplinary focus the rehabilitation facilities still fared poorly in their approach to this disease. This puts the onus on primary care physicians to provide adequate osteoporosis treatment in this group of patients, otherwise elderly people will continue to be under-managed for this disease.
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