title: Adherence to therapeutic and diagnostic recommendations in patients with femur fracture and at risk of re-fracture or death: results of an analysis of administrative databases.
abstract: The aim of the present study was to evaluate the application into clinical practice of therapeutic and diagnostic recommendations for the prevention of bone re-fracture in postmenopausal women after an hospitalization for hip fracture in clinical practice and to assess the relationship between the application of diagnostic recommendations and re-fracture or death risk. A retrospective cohort analysis was conducted.  All female patients, at least 65 years old, and with an hospitalization with main or secondary diagnosis of hip fracture during the period 1 January 2006 - 31 December 2008, were included. Besides demographic characteristics and comorbidities, drug treatment prescriptions related to bone fracture or supplementary with calcium or vitamin D and prescriptions of recommended laboratory and instrumental diagnostic tests (e.g. spine radiography), were analysed. A total of 5,636 patients were included in the study. The prescription of a drug treatment aimed to reduce the risk of re-fracture was found in 16.3% of patients, among them 76.3% (699 patients) used bisphosphonates only, 17.1% (157 patients) strontium ranelate only and 4.9% (45 patients) used more than one treatment during the observation period. Among the patients who did not receive drug treatment, 17.5% made use of only supplemental calcium and vitamin D. The remaining part of patients (69.1%) received no treatment. The prescription of at least one laboratory test of first and second level was performed, respectively, on 53.7% and 43.1% of included patients, whereas the prescription of at least one instrumental test of first and second level was performed, respectively, on 5.9% and 0.8%. Although it is established that the prescription of the recommended tests and appropriate drug treatment are significantly associated with reduced risk of re-fracture and death, today the application of these recommendations is reduced.
authors.affiliation: CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy. luca.degliesposti@clicon.it
authors.forename: L
authors.initials: L
authors.lastname: Degli Esposti
authors.forename: L
authors.initials: L
authors.lastname: Sinigaglia
authors.forename: M
authors.initials: M
authors.lastname: Rossini
authors.forename: S
authors.initials: S
authors.lastname: Adami
authors.forename: C
authors.initials: C
authors.lastname: Cagnoni
authors.forename: C
authors.initials: C
authors.lastname: Magliaro
authors.forename: C
authors.initials: C
authors.lastname: Veronesi
authors.forename: S
authors.initials: S
authors.lastname: Buda
authors.forename: S
authors.initials: S
authors.lastname: Minisola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data*; D004164:Diphosphonates / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006296:Health Services / Q000706:statistics & numerical data; D006298:Health Services Administration / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008498:Medical Record Linkage; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D055656:Prescriptions / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013876:Thiophenes / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D013876:Thiophenes; C081587:strontium ranelate; D014807:Vitamin D; D002118:Calcium