Evaluation and Management of Osteoporosis Following Hospitalization for Low-impact Fracture

Authors

  • Christine Simonelli MD,

    Corresponding author
    1. Received from the Department of Internal Medicine, Osteoporosis Services, HealthEast Clinics (CS, JM), Woodbury, Minn; and the Department of Outcomes and Management, U.S. Human Health, Merck and Co., Inc. (Y-TC, AFL, TAA) West Point, Pa.
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  • Ya-Ting Chen PhD, MPH,

    1. Received from the Department of Internal Medicine, Osteoporosis Services, HealthEast Clinics (CS, JM), Woodbury, Minn; and the Department of Outcomes and Management, U.S. Human Health, Merck and Co., Inc. (Y-TC, AFL, TAA) West Point, Pa.
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  • Julie Morancey CMA,

    1. Received from the Department of Internal Medicine, Osteoporosis Services, HealthEast Clinics (CS, JM), Woodbury, Minn; and the Department of Outcomes and Management, U.S. Human Health, Merck and Co., Inc. (Y-TC, AFL, TAA) West Point, Pa.
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  • Anne F. Lewis MS,

    1. Received from the Department of Internal Medicine, Osteoporosis Services, HealthEast Clinics (CS, JM), Woodbury, Minn; and the Department of Outcomes and Management, U.S. Human Health, Merck and Co., Inc. (Y-TC, AFL, TAA) West Point, Pa.
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  • Thomas A. Abbott III PhD

    1. Received from the Department of Internal Medicine, Osteoporosis Services, HealthEast Clinics (CS, JM), Woodbury, Minn; and the Department of Outcomes and Management, U.S. Human Health, Merck and Co., Inc. (Y-TC, AFL, TAA) West Point, Pa.
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  • Portions of these study results were presented in a poster format at the National Osteoporosis Foundation/International Osteoporosis Foundation meeting, June 2001, Chicago, Ill.

Address correspondence and requests for reprints to Dr. Simonelli: Osteoporosis Services, Internal Medicine, HealthEast Clinic, 1875 Woodwinds Dr., Woodbury, MN 55125 (e-mail: msciao@attbi.com).

Abstract

OBJECTIVE: To evaluate the pattern of osteoporosis evaluation and management in postmenopausal women who present with low-impact (minimal trauma) fracture.

DESIGN: Retrospective chart review of patients admitted with a fracture in the absence of trauma or bone disease. Telephone follow-up survey was conducted at 12 months after discharge to collect information on physician visits, pharmacological therapies for osteoporosis, functional status, and subsequent fractures.

PATIENTS/PARTICIPANTS: Postmenopausal women admitted to a hospital in St. Paul, Minnesota between June 1996 and December 1997 for low-impact fractures were identified. Low-impact fracture was defined as a fracture occurring spontaneously or from a fall no greater than standing height. Retrospective review of 301 patient medical records was conducted to obtain data on pre-admission risk factors for osteoporosis and/or fracture, and osteoporosis-related evaluation and management during the course of hospitalization. Follow-up 1 year after the incident fracture was obtained on 227 patients.

MEASUREMENTS AND MAIN RESULTS: Two hundred twenty-seven women were included in the study. Osteoporosis was documented in the medical record in 26% (59/227) of the patients at hospital discharge. Within 12 months of hospital discharge, 9.6% (22/227) had a bone mineral density test, and 26.4% (60/227) were prescribed osteoporosis treatment. Of those who were prescribed osteoporosis treatment, 86.6% (52/60) remained on therapy for 1 year. Nineteen women suffered an additional fracture. Compared to women without a prior fracture, women with at least 1 fracture prior to admission were more likely to have osteoporosis diagnosed and to receive osteoporosis-related medications.

CONCLUSION: Despite guidelines that recommend osteoporosis evaluation in adults experiencing a low-trauma fracture, we report that postmenopausal women hospitalized for low-impact fracture were not sufficiently evaluated or treated for osteoporosis during or after their hospital stay. There are substantial opportunities for improvement of care in this high-risk population to prevent subsequent fractures.

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