Expert physician recommendations and current practice patterns for evaluating and treating men with osteoporotic hip fracture.
OBJECTIVE
To develop recommendations for the evaluation and the treatment of men with osteoporotic hip fracture from expert publications in the field of male osteoporosis, and to define the current practice patterns in a tertiary care VA Medical Center in Durham, North Carolina.


METHODS
Survey research; a retrospective cohort study.


METHODS
Tertiary care VA Medical Center in Durham, North Carolina.


METHODS
(1) US physicians who published on the subject of male osteoporosis in the peer-reviewed literature between 1993 and 1997 identified by MEDLINE database search. (2) All 119 men admitted to the Durham VA Medical Center with ICD9 code for hip fracture between 1994 and 1998.


METHODS
(1) Osteoporosis evaluation and treatment recommendations of published physicians obtained by survey instrument. (2) Actual osteoporosis evaluation completed and therapy prescribed during index hospitalization in a cohort of men with hip fractures, determined by chart and database review.


RESULTS
(1) Forty-three physician-researchers were surveyed with an 84% response rate. For an osteoporosis evaluation, 89% of respondents recommended measuring serum testosterone, 85% serum calcium, 75% 25-OH vitamin D levels, 73% myeloma screen, and 61% serum thyroid-stimulating hormone (TSH). Dual Energy X-ray Absorptiometry would be obtained by 92%. More than 70% recommended calcium, vitamin D, and bisphosphonates for men with a normal metabolic evaluation, and 60% suggested weight-bearing exercise. (2) In the cohort of men admitted with hip fractures, 50% had a serum calcium level and 3% had a serum TSH level measured. Vitamin D was prescribed to 25% of patients in the form of a multivitamin, and 4% received calcium. There was no bisphosphonate, testosterone, or calcitonin use.


CONCLUSIONS
Physicians who have published on osteoporosis recommended metabolic evaluation and osteoporosis therapy after hip fracture. Only minimal evaluation and treatment occurred in a cohort of men with osteoporotic hip fractures.
Colón-Emeric
C
C
Duke University Medical Center, Durham VAMC Dept of Geriatrics Research and Education Clinical Center, North Carolina 27705, USA.
Yballe
L
L
Sloane
R
R
Pieper
C F
CF
Lyles
K W
KW
D015502:Absorptiometry, Photon; D000368:Aged; D002118:Calcium / Q000097:blood / Q000627:therapeutic use; D006620:Hip Fractures / Q000209:etiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D009657:North Carolina; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013739:Testosterone / Q000097:blood; D014481:United States; D014493:United States Department of Veterans Affairs; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use
D014807:Vitamin D; D013739:Testosterone; C104450:25-hydroxyvitamin D; D002118:Calcium