title: Effect of hospitalist consultation on treatment of osteoporosis in hip fracture patients.
abstract: The objective of this study was to determine if hospitalist consultation during admission for hip fracture results in improved treatment for osteoporosis. This was a retrospective chart review, carried out in a university-based academic hospital. Administrative discharge data was used to identify patients discharged between 1 September 1999 and 1 September 2001, discharged with the diagnosis of hip fracture. Eighty-two patient charts were reviewed after exclusion for traumatic and pathologic fractures. Treatment for osteoporosis consisted of medications recommended by the National Osteoporosis Foundation (NOF), including calcium (+/-vitamin D), estrogen, raloxifene, calcitonin, alendronate and risedronate. Osteoporosis treatment improvement was defined as the addition of a medication for osteoporosis that strengthened treatment. Twenty-nine percent of patients in our study received treatment for osteoporosis at the time of discharge from the hospitalization for hip fracture. While 20% received calcium, only 7% received a bisphosphonate. Twelve percent received improvement in osteoporosis treatment from admission to discharge. Those that received hospitalist consultation did not have a significant improvement in osteoporosis treatment (P=0.314), but had significantly more co-morbid illnesses and were significantly older than those receiving no consultation (P<0.05). Identification of osteoporosis as a medical problem was significantly associated with osteoporosis treatment (P<0.05). Potential barriers to hospitalist consultation's effect on osteoporosis treatment included patient age and co-morbidities. Further research is needed to identify and overcome barriers to effective osteoporosis treatment in patients with fractures.
authors.affiliation: Division of General and Geriatric Medicine, Department of Internal Medicine, Kansas University School of Medicine, Kansas, USA. cjachna@kumc.edu
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Jachna
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
authors.forename: Barbara
authors.initials: B
authors.lastname: Lukert
authors.forename: Leland
authors.initials: L
authors.lastname: Graves
authors.forename: Tarun
authors.initials: T
authors.lastname: Bhargava
mesh_terms: D000368:Aged; D002118:Calcium / Q000627:therapeutic use; D004363:Drug Utilization; D005260:Female; D006620:Hip Fractures / Q000209:etiology*; D020445:Hospitalists; D006760:Hospitalization; D006801:Humans; D007615:Kansas; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002118:Calcium