Secondary prevention of hip fractures among the hospitalized elderly: are we doing enough?

BACKGROUND Older individuals with hip fractures almost always have osteoporosis. Such individuals are at increased risk of experiencing other osteoporotic fractures, including recurrent hip fractures. The management of such patients should include assessing bone mineral density and treating osteoporosis. OBJECTIVE The objective of this study was to investigate if elderly (> or =65 years) patients with hip fractures were assessed and treated for osteoporosis. METHODS A retrospective chart review was conducted of all elderly patients who underwent hip fracture surgery at a university teaching hospital during the calendar years 1997 to 1999. RESULTS A total of 95 subjects were identified (29% males and 71% females). Subjects' age ranged from 65 to 96 years with a mean (+/-standard deviation) 81 +/- 7 years. Femoral neck fractures were the most common (51%), followed by intertrochanteric (43%) and subtrochanteric fractures (3%). Two subjects (2%) had fractures at multiple sites. The most common cause of a hip fracture was a fall (87%). Other causes included motor vehicle accidents (6%) as well as other trauma (4%). One subject had a spontaneous hip fracture. A history of hip fractures was obtained in 8% of subjects. Osteoporosis was diagnosed in 17% of subjects before admission. On admission, 9% of subjects were receiving calcium, 3% were receiving vitamin D, none were receiving alendronate, and 1 subject was receiving calcitonin. Approximately 3% of female subjects were receiving estrogen on admission. On discharge, 11% of subjects were prescribed calcium, 6% were prescribed vitamin D, none were prescribed alendronate, and 2% were on calcitonin. None of the female subjects were discharged on estrogen. During hospitalization, 88% of subjects who were admitted to nonmedical services were seen by either a geriatric or a general internal medicine consult. Obtaining a medical and/or geriatric consult did not have an apparent effect on the frequency of treating osteoporosis in this high-risk group of subjects. CONCLUSION Older adults with hip fractures are not adequately treated for osteoporosis. This places them at increased risk of other osteoporotic fractures, including recurrent hip fractures.