Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture.
OBJECTIVE
Although osteoporosis treatment can dramatically reduce fracture risk, rates of treatment after hip fracture remain low. In-hospital initiation of recommended medications has improved outcomes in heart disease; hospitalization for hip fracture may represent a similar opportunity for improvement. The objective of this study was to examine rates of in-hospital treatment with a combination of calcium and vitamin D (Cal+D) and antiresorptive or bone-forming medications in patients hospitalized for hip fractures


METHODS
Observational cohort.


METHODS
Three hundred eighteen hospitals in the United States.


METHODS
Fifty-one thousand three hundred forty-six patients aged 65 and older hospitalized for osteoporotic hip fracture.


METHODS
In-hospital administration of Cal+D and antiresorptive or bone-forming medications.


RESULTS
Three thousand four hundred five patients (6.6%) received Cal+D anytime after a procedure to correct femoral fracture; 3,763 patients (7.3%) received antiresorptive or bone-forming medications. Only 1,023 patients (2.0%) were prescribed ideal therapy, receiving Cal+D and an antiresorptive or bone-forming medication. Treatment rates remained low across virtually all patient-, provider-, and hospital-level characteristics. The strongest predictor of treatment with Cal+D was the receipt of an antiresorptive or bone-forming medication (adjusted odds ratio=5.50, 95% confidence interval=4.84-6.25), but only 27.2% of patients who received these medications also received Cal+D.


CONCLUSIONS
Rates of in-hospital initiation of osteoporosis treatment for patients with hip fracture are low and may represent an opportunity to improve care.
Jennings
Lee A
LA
San Francisco VA Medical Center, and Department of Medicine, University of California San Francisco, San Francisco, California, USA. lee.jennings@ucsf.edu
Auerbach
Andrew D
AD
Maselli
Judith
J
Pekow
Penelope S
PS
Lindenauer
Peter K
PK
Lee
Sei J
SJ
D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium
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