Medical management of patients over 50 years admitted to orthopedic surgery for low-energy fracture.
OBJECTIVE
To develop a cost-effective strategy for improving osteoporosis management in patients admitted to an orthopedic surgery department for low-energy fractures.


METHODS
From November 2003 to July 2004, all patients over 50 years admitted to the orthopedics department of the Caen Teaching Hospital (France) for low-energy fractures were identified and evaluated by rheumatology department physicians in the same hospital.


RESULTS
During the study period, 313 patients were identified, 257 women (mean age, 79.5+/-10.2 years) and 56 men (mean age, 74.6+/-10.8 years), each with one fracture (proximal femur, 58.9%; wrist, 13%). Among them, 91 (29%) had a previous history of osteoporotic fractures. Mean bone mineral density (BMD) values were lower at the femoral neck than at the total hip or lumbar spine (e.g. in women, -2.3+/-0.9 versus -1.8+/-1.0 and -1.4+/-1.7, respectively). Osteoporosis treatment was given to 88 (28%) patients and consisted of calcium and vitamin D supplements, combined with alendronate in 32 patients. Complete loss of self-sufficiency occurred in 73 patients. Thus, 161 patients (88 with osteoporosis treatment and 73 with loss of self-sufficiency) received optimal treatment.


CONCLUSIONS
Cooperation between the orthopedics and rheumatology departments improved the management of osteoporosis in patients with low-energy fractures. However, appropriate investigation and treatment of osteoporosis proved difficult in the oldest old and in patients with cognitive impairments.
Levasseur
Régis
R
Rheumatology Department, Côte de Nacre Teaching Hospital, 14033 Caen, France.
Sabatier
Jean-Pierre
JP
Guilcher
Catherine
C
Guaydier-Souquières
Geneviève
G
Costentin-Pignol
Valérie
V
Jean-Jacques
Pierre-Yves
PY
Hulet
Christophe
C
Vielpeau
Claude
C
Marcelli
Christian
C
D015502:Absorptiometry, Photon; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage; D019587:Dietary Supplements; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000628:therapy*; D005602:France; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009985:Orthopedics / Q000458:organization & administration / Q000706:statistics & numerical data*; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012017:Referral and Consultation / Q000458:organization & administration*; D012219:Rheumatology / Q000458:organization & administration*; D014807:Vitamin D / Q000008:administration & dosage
D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D014807:Vitamin D