title: Compliance of an elderly hip fracture population with secondary preventative measures. Efficacy of a simple clinical practice intervention.
abstract: Secondary pharmaceutical measures are effective in all age groups for the prevention of osteoporotic fractures. This prospective study determines the demographics of 566 consecutive osteoporotic hip fractures presenting to a Level 1 Trauma Center. We examine the efficacy of simple treatment recommendations for pharmaceutical treatment of osteoporosis and the factors determining general practitioner and patient compliance with these recommendations in a community setting. One out of four patients (24.5%) had sustained a previous fragility fracture. Mean age was 80 years. Twenty five percent were resident in a nursing home and only 10% were taking anti-resorptive therapy preoperatively. In hospital mortality was 6%, and 39% of recruited patients were dead at 12 months. By this time more than half the survivors were resident in a nursing home. The compliance with anti-resorptive therapy had increased to over 70% consequent to our simple recommendations. Significant differences in GP and patient compliance were observed between nursing home and own residence dwellers. This study demonstrates the efficacy of a simple clinical practice intervention in increasing patient and GP compliance with secondary fracture prevention measures. We also discuss many of the confounding issues determining this compliance.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, Ireland. hrb_street@yahoo.com
authors.forename: John
authors.initials: J
authors.lastname: Street
authors.forename: Brian
authors.initials: B
authors.lastname: Lenehan
authors.forename: Tony
authors.initials: T
authors.lastname: Higgins
authors.forename: David
authors.initials: D
authors.lastname: Mulcahy
authors.forename: George
authors.initials: G
authors.lastname: Mullan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005194:Family Practice; D005260:Female; D006620:Hip Fractures / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D010349:Patient Compliance; D011446:Prospective Studies; D012008:Recurrence