Osteoporosis Care Gap in Hip Fracture Patients – First Data from Latvia

Presentation Number: FRI-259
Date of Presentation: March 6th, 2015

Maija Mukane*1, Ingvars Rasa2 and Maksims Mukans3
1Riga Stradins University, Riga East Clinical University Hospital, Latvian Osteoporosis and Bone Metabolism Diseases Association, Riga, Latvia, 2Riga East Clinical University Hospital, Riga Stradins University, Latvian Osteoporosis and Bone Metabolism Diseases Association, Riga, Latvia, 3Riga Stradins University, Riga East Clinical University Hospital, Riga, Latvia

Abstract

Background: Major health consequences of osteoporosis (OP) are fragility fractures, disablement, chronic pain, high morbidity and mortality risk. OP management may not be viewed as a high priority during in–hospital care, however it is obligatory in outpatient work–up. The aim of the study was to analyse reasons of OP care gap in hip fracture patients (pts) in one of the Northern Europe Union countries – Latvia.

Materials and methods: Retrospective quantitative medical record analysis included time period of three years (yrs), till 2012. In above–mentioned term totally 5050 pts with trauma admitted in the Riga 2nd Hospital. From them 888 pts had fragility hip fracture and were included in the study. Pts demographic characteristics, health status, OP risk factors (lifestyle factors, co–morbidities and used medications) and recommendations at discharge were analysed. All scale data were presented in median with the interquartile range.

Results: Mostly females (73.1%), older than males (80 (86–72) yrs vs 72 (80–61) yrs, p<0.001). Median hospital stay 15 (18–13) days. Most common hip fracture type was pertrochanteric fracture (41.8%) treated operatively (82.1% of all pts) using intramedullary hip screw (76.1%). Information about smoking and alcohol abuse was found in 20.4% pts medical records. Co–morbidities increasing risk of OP (e.g., diabetes mellitus, rheumatoid arthritis or sarcoidosis) had 24.4% (n=217) of all pts. Medications increasing risk of OP (e.g., proton pump inhibitors, anticonvulsants or loop diuretics) used 6.2% (n=55) of all pts. Glucocorticosteroids in the long term used 1.4% (n=12) of all pts. Previous fracture as a result of low energy trauma had 14.8% (n=131) of all pts and 9.2% of them had more than one fracture. Most of the pts had 1–2 OP risk factors (80.1% of all pts), more than 3 OP risk factors had 11.2% of all pts and six or more risk factors had 3% of them. Only 2.5% (n=22) of all pts received recommendations for further OP evaluation or treatment at discharge (e.g., perform osteodensitometry, calcium and vitamin D supplementation or specific OP treatment). More often recommendations received pts with 1–2 OP risk factors (77.3%, n=17). There was no difference in recommendations at discharge in comparison between pts with no risk factors and pts with 3–6 risk factors (p=0.662).

Conclusions: Although the study was retrospective medical record review and we were unable to recognize all OP risk factors and why target population did not received recommendations, reasons of OP care gap in hip fracture patients in Latvia could be omission of OP risk factors and lack of communication between specialists (e.g., traumatologist and general practitioner) involved in OP care.

 

Nothing to Disclose: MM, IR, MM