Undertreatment of osteoporosis in men with hip fracture.
BACKGROUND
Women are not aggressively treated for osteoporosis after hip fracture; the treatment status of men with hip fracture has not been extensively studied.


OBJECTIVE
To evaluate the outcome and treatment status of men with hip fracture.


METHODS
Data from medical records were obtained for 363 patients (110 men and 253 women) aged 50 years and older with atraumatic (low-energy) hip fracture who were admitted to St Luke's Episcopal Hospital between January 1, 1996, and December 31, 2000. Surveys were mailed to surviving patients. Main outcome variables were osteoporosis treatments (antiresorptive or calcium and vitamin D) at hospital discharge, current osteoporosis treatments at 1- to 5-year follow-up, bone mineral density testing, mortality, current disability, and living arrangements (home or institution).


RESULTS
The mean age for men was 80 years vs 81 years for women. Most fractures (89% for men and 93% for women) resulted from falls from a standing height. At hospital discharge, 4.5% of men (n = 5) had treatment of any kind for osteoporosis, compared with 27% of women (n = 69) (P<.001). The 12-month mortality was 32% in men, compared with 17% in women (P =.003). Surveys were usable from 168 (87%) of 194 survivors. At 1- to 5-year follow-up, 27% (12/44) of men were taking treatment of any kind for osteoporosis, compared with 71% (88/124) of women (P<.001). Of those treated, 67% (8/12) of men and 32% (28/88) of women were taking calcium and vitamin D only. At 1- to 5-year follow-up, 11% of men had a bone mineral density measurement, compared with 27% of women. After hospital discharge, the number of men and women who required wheelchairs, walkers, and canes and who lived in institutions increased significantly.


CONCLUSIONS
The burden of hip fracture is illustrated by the high incidence of postfracture disability and the high mortality rate in both men and women. Nevertheless, few men receive antiresorptive treatment.
Kiebzak
Gary M
GM
Center for Orthopaedic Research and Education, St Luke's Episcopal Hospital, 6720 Bertner Ave, Mail Stop MC4-183, Houston, TX 77030, USA. gkiebzak@sleh.com
Beinart
Garth A
GA
Perser
Karen
K
Ambrose
Catherine G
CG
Siff
Sherwin J
SJ
Heggeness
Michael H
MH
D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003625:Data Collection; D005260:Female; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D016138:Walking