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Archives of Osteoporosis

, 13:6 | Cite as

Are we treating osteoporotic fractures of the hip adequately? A Middle Eastern cohort study

  • K. Venugopal MenonEmail author
  • Huda Hamed Salim Al Harthy
  • Khalid Shafi Khalid Al Habsi
  • Hind Abdullah Hamed Al Ruzaiqi
Original Article
  • 138 Downloads

Abstract

Summary

Fragility hip fractures treated in a center in the Middle East were retrospectively studied for adequacy of osteoporosis management. Of the 318 patients treated, over 70% did not have a structured investigation and about 30% did not receive any therapeutic supplements. Our series showed a preventable 8.8% secondary fracture rate.

Purpose

To study the adequacy of evaluation and treatment of osteoporosis after fragility fractures of the hip. The study also attempts to estimate the prevalence of secondary fractures after the original injury.

Methods

This is a retrospective evaluation of the electronic database to search all the admissions for fractures of the hip in patients over 50 years at a tertiary care Trauma and Orthopaedic center in the Sultanate of Oman. The study period was defined as October 2010 to December 2015. Their case records, BMD reports, and laboratory data were analyzed. Pharmacological interventions and the documented compliance with such therapy were also recorded.

Results

Over the study period, 318 fragility fractures of the hip were treated. Of these, 233 (73.3%) did not receive a DEXA scan and 94% did not have their vitamin D3 (vit D) tested. About 29.9% percent cases did not receive any nutritional supplement or therapeutic intervention though diagnosed as fragility fracture. Twenty-eight patients (8.8%) reported for secondary fractures of the hip. Of these, 86% was initiated on supplement after their index fracture though 78.6% had not had a BMD study.

Conclusions

Less than 27% patients receive BMD test following fragility fracture of the hip and only 6% a vit D3 assay. Secondary fractures of the hip tend to occur in approximately 9% of the cases in Oman; this seems to occur equally in patients who have had as well as not had any calcium and vit D supplements after the index injury.

Keywords

Secondary fracture Hip fracture Fragility fracture of hip Osteoporosis in the Middle East Vitamin D deficiency 

Notes

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E (2012) ASBMR task force on secondary fracture prevention. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27(10):2039–2046.  https://doi.org/10.1002/jbmr.1698 CrossRefPubMedGoogle Scholar
  2. 2.
    Sale JE, Beaton D, Bogoch E (2014) Secondary prevention after an osteoporosis-related fracture: an overview. Clin Geriatr Med 30(2):317–332.  https://doi.org/10.1016/j.cger.2014.01.009 CrossRefPubMedGoogle Scholar
  3. 3.
    Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH, McLellan AR, Stenmark J, Pierroz DD, Schneider MC, Kanis JA, Akesson K, Cooper C, IOF Fracture Working Group; EXCO (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool. Osteoporos Int 26(11):2573–2578.  https://doi.org/10.1007/s00198-015-3192-0 CrossRefPubMedGoogle Scholar
  4. 4.
    Drew S, Judge A, May C, Farmer A, Cooper C, Javaid MK, Gooberman-Hill R, REFReSH study group (2015) Implementation of secondary fracture prevention services after hip fracture: a qualitative study using extended Normalization Process Theory. Implement Sci 10(1):57.  https://doi.org/10.1186/s13012-015-0243-z CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, AR ML, Mitchell PJ, Sale JE, Wahl DA, IOF CSA Fracture Working Group (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22(7):2051–2065.  https://doi.org/10.1007/s00198-011-1642-x CrossRefPubMedGoogle Scholar
  6. 6.
    Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C, IOF Fracture Working Group (2013) Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24(8):2135–2152.  https://doi.org/10.1007/s00198-013-2348-z CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Osuna PM, Ruppe MD, Tabatabai LS (2017) Fracture liaison services: multidisciplinary approaches to secondary fracture prevention. Endocr Pract 23(2):199–206.  https://doi.org/10.4158/EP161433.RA CrossRefPubMedGoogle Scholar
  8. 8.
    Al-Shoumer KA, Nair V (2010) Prevalence of low bone mass in postmenopausal Kuwaiti women residents in the largest province of Kuwait. Arch Osteoporos 7(1-2):147–153.  https://doi.org/10.1007/s11657-012-0092-1 CrossRefGoogle Scholar
  9. 9.
    Balasubramanian A, Tosi LL, Lane JM, Dirschl DR, Ho PR, O'Malley CD (2014) Declining rates of osteoporosis management following fragility fractures in the U.S. 2000 through 2009. J Bone Joint Surg Am 96(7):e52–1-8.  https://doi.org/10.2106/JBJS.L.01781 CrossRefPubMedGoogle Scholar
  10. 10.
    Mettyas T, Carpenter C (2013) Secondary prevention of osteoporosis in non-neck of femur fragility fractures: is it value for money? A retrospective, prospective and cross-sectional cohort study. J Orthop Surg Res 8(1):44.  https://doi.org/10.1186/1749-799X-8-44 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Munson JC, Bynum JP, Bell JE, Cantu R, McDonough C, Wang Q, Tosteson TD, Tosteson AN (2016) Patterns of prescription drug use before and after fragility fracture. JAMA Intern Med 176(10):1531–1538.  https://doi.org/10.1001/jamainternmed.2016.4814 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Benzvi L, Gershon A, Lavi I, Wollstein R (2016) Secondary prevention of osteoporosis following fragility fractures of the distal radius in a large health maintenance organization. Arch Osteoporos 11(1):20.  https://doi.org/10.1007/s11657-016-0275-2 CrossRefPubMedGoogle Scholar
  13. 13.
    Petrella RJ, Jones TJ (2006) Do patients receive recommended treatment of osteoporosis following hip fracture in primary care? BMC Fam Pract 7(1).  https://doi.org/10.1186/1471-2296-7-31
  14. 14.
    Bruyere O, Brandi ML, Burlet N, Harvey N, Lyritis G, Minne H, Boonen S, Reginster JY, Rizzoli R, Akesson K (2008) Post-fracture management of patients with hip fracture: a perspective. Curr Med Res Opin 24(10):2841–2851.  https://doi.org/10.1185/03007990802381430 CrossRefPubMedGoogle Scholar
  15. 15.
    Byszewski AM, Cranney A, Man-Son-Hing M, Azad N, Amos S (2006) Evaluation of in-hospital management of fracture risk in older patients: a chart review study of tertiary prevention. Arch Gerontol Geriatr 42(3):319–328.  https://doi.org/10.1016/j.archger.2005.08.004 CrossRefPubMedGoogle Scholar
  16. 16.
    Kamel HK (2005) Secondary prevention of hip fractures among the hospitalized elderly: are we doing enough? J Clin Rheumatol 11(2):68–71.  https://doi.org/10.1097/01.rhu.0000158545.26370.5c CrossRefPubMedGoogle Scholar
  17. 17.
    Drew S, Judge A, Cooper C, Javaid MK, Farmer A, Gooberman-Hill R (2016) Secondary prevention of fractures after hip fracture: a qualitative study of effective service delivery. Osteoporos Int 27(5):1719–1727.  https://doi.org/10.1007/s00198-015-3452-z CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Drew S, Sheard S, Chana J, Cooper C, Javaid MK, Judge A, REFReSH study group (2014) Describing variation in the delivery of secondary fracture prevention after hip fracture: an overview of 11 hospitals within one regional area in England. Osteoporos Int 25(10):2427–2433.  https://doi.org/10.1007/s00198-014-2775-5 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bachour F, Rizkallah M, Sebaaly A, Barakat A, Razzouk H, El Hage R, Nasr R, El Khoury M, Maalouf AG (2017) Fracture liaison service: report on the first successful experience from the Middle East. Arch. Osteoporos 12(1):79.  https://doi.org/10.1007/s11657-017-0372-x CrossRefPubMedGoogle Scholar
  20. 20.
    Hreybe H, Salamoun M, Badra M, Afeiche N, Baddoura O, Boulos S, Haidar R, Lakkis S, Musharrafieh R, Nsouli A, Taha A, Tayim A, El-Hajj Fuleihan G (2004) Hip fractures in Lebanese patients: determinants and prognosis. J Clin Densitom 7(4):368–375.  https://doi.org/10.1385/JCD:7:4:368 CrossRefPubMedGoogle Scholar
  21. 21.
    El-Desouki MI (2003) Osteoporosis in postmenopausal Saudi women using dual x-ray bone densitometry. Saudi Med J 24(9):953–956PubMedGoogle Scholar
  22. 22.
    Bubshait D, Sadat-Ali M (2007) Economic implications of osteoporosis-related femoral fractures in Saudi Arabian society. Calcif Tissue Int 81(6):455–458.  https://doi.org/10.1007/s00223-007-9090-5 CrossRefPubMedGoogle Scholar
  23. 23.
    Gupta R, Al-saeed O, Azizieh F, Albusairi A, Gupta P, Mohammed A (2012) Evaluation of bone mineral density in postmenopausal women in Kuwait. J Clin Densitom 15(2):211–216.  https://doi.org/10.1016/j.jocd.2011.10.006 CrossRefPubMedGoogle Scholar
  24. 24.
    Fuleihan GE. Stenmark J, Misteli L. (Eds). (2011). The Middle East and Africa regional Audit: epidemiology, costs & burden of osteoporosis in 2011. International Osteoporosis Foundation 102011–5000.Google Scholar
  25. 25.
    Mahussain S, Badr H, Al-Zaabi K, Mohammad M, Alnafisi N (2006) Bone mineral density in healthy Kuwaiti women. Arch Osteoporos 1:51–57CrossRefGoogle Scholar
  26. 26.
    Shukla JJ, Khandekar RB (2008) Magnitude and determinants of osteoporosis in adult population of South Sharqiya region of Oman. Saudi Med J. 29(7):984–988PubMedGoogle Scholar
  27. 27.
    Patel VP, Mathew R, Raptis D, Christofi T, Youngman J (2010) Overcoming barriers to secondary prevention in hip fracture patients: an electronic referral and management system for osteoporosis. Injury 41(12):1249–1255.  https://doi.org/10.1016/j.injury.2010.05.006 CrossRefPubMedGoogle Scholar
  28. 28.
    Mitchell PJ, Chem C (2013) Secondary prevention and estimation of fracture risk. Best Pract Res Clin Rheumatol 27(6):789–803.  https://doi.org/10.1016/j.berh.2013.11.004 CrossRefPubMedGoogle Scholar
  29. 29.
    Mitchell P, Åkesson K, Chandran M, Cooper C, Ganda K, Schneider M (2016) Implementation of models of care for secondary osteoporotic fracture prevention and orthogeriatric models of care for osteoporotic hip fracture. Best Pract Res Clin Rheumatol 30(3):536–558.  https://doi.org/10.1016/j.berh.2016.09.008 CrossRefPubMedGoogle Scholar
  30. 30.
    Huntjens KM, van Geel TA, van den Bergh JP, van Helden S, Willems P, Winkens B, Eisman JA, Geusens PP, Brink PR (2014) Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am 96(4):e29.  https://doi.org/10.2106/JBJS.L.00223 CrossRefPubMedGoogle Scholar
  31. 31.
    Bogoch ER, Elliot-Gibson V, Beaton D, Sale J, Josse RG (2017) Fracture prevention in the orthopaedic environment: outcomes of a coordinator-based fracture liaison service. J Bone Joint Surg Am 99(10):820–831.  https://doi.org/10.2106/JBJS.16.01042 CrossRefPubMedGoogle Scholar
  32. 32.
    Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 10(12):117–127.  https://doi.org/10.2147/CIA.S85551 eCollection 2017CrossRefGoogle Scholar
  33. 33.
    Tosi LL, Gliklich R, Kannan K, Koval KJ (2008) The American Orthopaedic Association’s “own the bone” initiative to prevent secondary fractures. J Bone Joint Surg Am 90(1):163–173.  https://doi.org/10.2106/JBJS.G.00682 CrossRefPubMedGoogle Scholar
  34. 34.
    Bessette L, Jean S, Davison KS, Roy S, Ste-Marie LG, Brown JP (2009) Factors influencing the treatment of osteoporosis following fragility fracture. Osteoporos Int 20(11):1911–1919.  https://doi.org/10.1007/s00198-009-0898-x CrossRefPubMedGoogle Scholar
  35. 35.
    Ip TP, Leung J, Kung AW (2010) Management of osteoporosis in patients hospitalized for hip fractures. Osteoporos Int 21(Suppl 4):S605–S614.  https://doi.org/10.1007/s00198-010-1398-8 CrossRefPubMedGoogle Scholar
  36. 36.
    Nurmi-Lüthje I, Lüthje P, Kaukonen JP, Kataja M, Kuurne S, Naboulsi H, Karjalainen K (2009) Post-fracture prescribed calcium and vitamin D supplements alone or, in females, with concomitant anti-osteoporotic drugs is associated with lower mortality in elderly hip fracture patients: a prospective analysis. Drugs Aging 26(5):409–421.  https://doi.org/10.2165/00002512-200926050-00005 CrossRefPubMedGoogle Scholar
  37. 37.
    Nurmi-Lüthje I, Sund R, Juntunen M, Lüthje P (2011) Post-hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs is associated with lower mortality: a nationwide study in Finland. J Bone Miner Res 26(8):1845–1853.  https://doi.org/10.1002/jbmr.375 CrossRefPubMedGoogle Scholar
  38. 38.
    Adler RA (2012) Secondary fracture prevention. Curr Osteoporos Rep 10(1):22–27.  https://doi.org/10.1007/s11914-011-0090-z CrossRefPubMedGoogle Scholar
  39. 39.
    Morin S, Rahme E, Behlouli H, Tenenhouse A, Goltzman D, Pilote L (2007) Effectiveness of antiresorptive agents in the prevention of recurrent hip fractures. Osteoporos Int 18(12):1625–1632.  https://doi.org/10.1007/s00198-007-0421-1 CrossRefPubMedGoogle Scholar
  40. 40.
    Trevisan C (2011) Secondary prevention of fractures and compliance to treatment in osteoporosis. Aging Clin Exp Res 23(2 Suppl):22–24PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • K. Venugopal Menon
    • 1
    Email author
  • Huda Hamed Salim Al Harthy
    • 1
  • Khalid Shafi Khalid Al Habsi
    • 1
  • Hind Abdullah Hamed Al Ruzaiqi
    • 1
  1. 1.Khoula HospitalMuscatSultanate of Oman

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