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AB0899 Challenges at Joetsu, Japan, to Prevent Secondary Fracture for Hip Fracture Patients – to Suppress an Increase by Spreading the Osteoporosis Treatment and Collaboration with Family Doctors
  1. K. Arai1,
  2. N. Suzuki1,
  3. J. Ajiro2
  1. 1Orthopaedic Surgery
  2. 2Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Niigata, Japan

Abstract

Background The Niigata Prefectural Central Hospital (NPCH) in Joetsu city is mainstay hospital of Joetsu and Myoko cities in Niigata prefecture, Japan, with population of 244,068 and a rate of ageing ≥65 years, 26.0% (n=63,566) in 2009. The population of ≥65 years is steadily increasing. Most of cases with hip fracture in NPCH were operated within 48hrs after injury in working hours and were treated with clinical path. Almost all hip fractures in this area have been operated in two hospitals. From 1985 to 2010, an incidence of hip fracture has steadily increased in Niigata prefecture.

Objectives A purpose is to show our trial in NPCH from 2009 to 2013 to suppress such a trend of an increase of fragility fracture in Joetsu City.

Methods A status in 2009: a number of hip fracture was 191 with the mean age, 83.4 years; the neck/trochanter (n/t) ratio, 0.47; a cause of fractures, a simple fall, 93%; a prescription rate of antiosteoporosis drug, 21%; concomitant treatment for chronic diseases with a family doctor, 89%. Those had previous history of hip fracture was 6% and only 11% of them had drug treatment for osteoporosis.

Because of the status above mentioned, two major challenges were started from 2010 as follows. Firstly, a challenge in the hospital comprised of a careful drug history taking on each patient by a hospital pharmacist, followed by an explanation of importance of drug therapy, and rehabilitation to maintain muscle power to prevent a fall by physiotherapists. Drug treatment for osteoporosis was definitely started in the hospital for prevention of a second hip fracture. Secondly, a challenge after discharge in a community: in order to enlighten the family doctors an importance of prevention of fragility fracture and an effect and availability of various drugs for osteoporosis were frequently lectured at the medical meetings and introduced by pharmaceutical companies.

Results The number of cases with hip fractures in 2012 was 167 and 203 in 2013. The proportion of the cases who had drug treatment for osteoporosis when fracture occurred, was 25% in 2012 and 41% in 2013. The n/t ratio was high in drug therapy group compared with non-therapy. The proportion of cases who had previous hip fracture was 9.6% in 2012 and 10.3% in 2013. Among them, 38% of patients in 2012 and 48% in 2013 had drug treatment for osteoporosis. The population ≥65 years in 2013 was 68,000. Most of the patients who could not continue the osteoporosis medications in spite of the previous hip fracture, had dementia.

The number of cases with hip fracture treated in the other hospital was 143 in 2009, 167 in 2012 and 156 in 2013. The total number of cases with hip fracture in our area was 334 in 2009, 334 in 2012, and 359 in 2013, where the population ≥65 years in 2013 increased about 4,500 compared with it in 2009.

Conclusions The proportion of hip fracture patients who had drug treatment for osteoporosis was increased, 21% in 2009 and 41% in 2013. The proportion of the cases who had previous hip fracture and drug treatment for osteoporosis was also increased, 11% in 2009 and 48% in 2013. Our results suggest an importance of osteoporosis treatment and multidisciplinary collaboration for prevention. Next target is to suppress the fragility fracture in cases who have dementia.

Disclosure of Interest None declared

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