title: Challenges to prevent secondary fractures in patients with hip fractures in Joetsu Myoko, Japan through the increased use of osteoporosis treatment and collaboration with family doctors.
abstract: The Niigata Prefectural Central Hospital (NPCH) is one of the main hospitals for the cities of Joetsu and Myoko, Niigata Prefecture, Japan, an area with a population of 240,141, of whom 26.7 % were aged ≥65 years in 2009. In the NPCH, patients with hip fractures are admitted to an orthopedic ward within 4 h, 89.2 % of patients are operated on within 48 h during working hours, and the prevalence of pressure ulcers is 1.5 %. To reduce the incidence of hip fractures, two major challenges emphasizing secondary fracture prevention were initiated in 2012. The first challenge used a team approach-hospital pharmacists asked patients about their drug use histories, orthopedic surgeons began drug therapy for osteoporosis after explaining to patients its importance for the prevention of secondary hip fractures, nurses assessed the risk of falling, and physiotherapists conducted rehabilitation with the aim of preventing falls. The second challenge focused on maintaining treatment for osteoporosis after discharge, when patients were under the oversight of family doctors. The percentages of patients with primary hip fractures who were taking anti-osteoporosis medications at the time of discharge in 2009, 2012, 2013 and 2014 were 21, 33, 41, and 43 %, respectively. The 12-month incidences of hip fractures on the unaffected side in 2009, 2012, 2013 and 2014 were 7.4, 2.2, 0, and 2.4 %, respectively, and the 24-month incidences of such fractures in 2009, 2012 and 2013 were 12, 7.6, and 5.2 %, respectively. Our challenges were effective at decreasing the incidence of secondary fractures.
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Suzuki
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan. araika23@npch.lamen.or.jp.
authors.forename: Katsumitsu
authors.initials: K
authors.lastname: Arai
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Saizo
authors.initials: S
authors.lastname: Kon
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Yamanaka
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Otsuka
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Koizumi
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Hosaka
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsuchiya
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Mochizuki
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kuraishi
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Murayama
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Tashi
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Oike
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Wakasugi
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu, Niigata, 9430192, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nakadai
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimati-dori 1, Niigata, 9518510, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Endo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy*; D058007:Physicians, Primary Care
keywords: Hip fracture; Osteoporosis treatment; Prevention; Secondary fracture; Team approach