title: Evaluation of in-hospital management of fracture risk in older patients: a chart review study of tertiary prevention.
abstract: Hip fractures are associated with considerable morbidity and mortality in the elderly. Both fall prevention strategies and bone integrity/osteoporosis assessment should be addressed in this population. This study's goal was to evaluate the management of potential re-fracture risk after a hip fracture in an acute care setting. This was a retrospective chart review of patients who were admitted with a hip fracture over the course of one year to the Ottawa Hospital, Civic Campus, Ottawa, Canada. The charts of 147 patients with hip fractures met the inclusion criteria. Use of sedatives on admission was significant (24.5%). Fifty (34%) had some form of osteoporosis management ordered during their hospital stay. The medication recommendations consisted of only 14% being prescribed Vitamin D and 15.6% being prescribed calcium supplementation. Merely 7 (4.8%) patients of the total sample were prescribed bisphosphonates at time of discharge. This study documents a significant care gap in re-fracture management at the time of acute hospitalization after an acute hip fracture. Interventions are required to increase the awareness that this problem is not being addressed at the time of hospitalization and that on discharge, patients will need follow-up by the treating community physician.
authors.affiliation: Division of Geriatric Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ont., Canada K1Y 4E9. abyszewski@ottawahospital.on.ca
authors.forename: Anna M
authors.initials: AM
authors.lastname: Byszewski
authors.forename: Ann
authors.initials: A
authors.lastname: Cranney
authors.forename: Malcolm
authors.initials: M
authors.lastname: Man-Son-Hing
authors.forename: Nahid
authors.initials: N
authors.lastname: Azad
authors.forename: Stephanie
authors.initials: S
authors.lastname: Amos
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D002118:Calcium / Q000008:administration & dosage; D002170:Canada; D019587:Dietary Supplements; D004164:Diphosphonates / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D005260:Female; D006620:Hip Fractures / Q000517:prevention & control / Q000628:therapy*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D010024:Osteoporosis / Q000517:prevention & control / Q000628:therapy*; D010346:Patient Care Management; D012189:Retrospective Studies; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D006993:Hypnotics and Sedatives; D014807:Vitamin D; D002118:Calcium