Systematic in-hospital screening and treatment for osteoporosis in a geriatric population with hip fractures

Background

Low-trauma fractures of the hip signify osteoporosis and increase the risk of a second fracture. However, screening for secondary osteoporosis and initiating osteoporosis treatment can be challenging in a geriatric population.

Objectives

To investigate an in-hospital approach to secure treatment, screening and follow-up of osteoporosis.

Methods

We evaluated the feasibility of a clinical approach to osteoporosis treatment with in-hospital zoledronic acid (ZOL) infusion, screening for secondary osteoporosis, and dual-energy X-ray absorptiometry (DXA) with a vertebral fracture assessment (VFA) in a cohort of 128 patients. We compared this cohort to a historic cohort of 135 patients, where screening and treatment were provided by general practice.

Results

In the intervention cohort, 58% of the patients received anti-osteoporosis treatment within 6 months of admission. Forty-eight patients (38%) received ZOL during admission, while nine continued their usual treatment. An additional 17 patients received ZOL or another anti-osteoporosis treatment within 6 months. The most common reasons for not receiving ZOL were vitamin D deficiency (24%) and renal impairment (7%). In total, 35% (n = 43) had a DXA within 6 months of admission; VFA revealed nine cases of vertebral fractures. Screening for secondary osteoporosis revealed vitamin D deficiency with and without secondary hyperparathyroidism (48%) and subclinical hyperthyroidism (8%) as the most common findings. Together, biochemical screening and VFA changed the treatment strategy in less than five cases.

Conclusion

Administering ZOL in-hospital following a hip fracture in combination with a systematic follow-up secured treatment in 6 out of 10 patients. However, compliance with DXA was low, which might not be of major concern, since DXA only individualized treatment in a few patients.