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Missed Opportunities for Osteoporosis Treatment in Patients Hospitalized for Hip Fracture
Author(s) -
Jennings Lee A.,
Auerbach Andrew D.,
Maselli Judith,
Pekow Penelope S.,
Lindenauer Peter K.,
Lee Sei J.
Publication year - 2010
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2010.02769.x
Subject(s) - medicine , hip fracture , osteoporosis , odds ratio , vitamin d and neurology , confidence interval , pediatrics
OBJECTIVES: Although osteoporosis treatment can dramatically reduce fracture risk, rates of treatment after hip fracture remain low. In‐hospital initiation of recommended medications has improved outcomes in heart disease; hospitalization for hip fracture may represent a similar opportunity for improvement. The objective of this study was to examine rates of in‐hospital treatment with a combination of calcium and vitamin D (Cal+D) and antiresorptive or bone‐forming medications in patients hospitalized for hip fractures DESIGN: Observational cohort. SETTING: Three hundred eighteen hospitals in the United States. PARTICIPANTS: Fifty‐one thousand three hundred forty‐six patients aged 65 and older hospitalized for osteoporotic hip fracture. MEASUREMENTS: In‐hospital administration of Cal+D and antiresorptive or bone‐forming medications. RESULTS: Three thousand four hundred five patients (6.6%) received Cal+D anytime after a procedure to correct femoral fracture; 3,763 patients (7.3%) received antiresorptive or bone‐forming medications. Only 1,023 patients (2.0%) were prescribed ideal therapy, receiving Cal+D and an antiresorptive or bone‐forming medication. Treatment rates remained low across virtually all patient‐, provider‐, and hospital‐level characteristics. The strongest predictor of treatment with Cal+D was the receipt of an antiresorptive or bone‐forming medication (adjusted odds ratio=5.50, 95% confidence interval=4.84–6.25), but only 27.2% of patients who received these medications also received Cal+D. CONCLUSION: Rates of in‐hospital initiation of osteoporosis treatment for patients with hip fracture are low and may represent an opportunity to improve care.