Authors (including presenting author) :
Cheng Thomas(1), Yu Teresa(1), Cheng HC(2), Hsu Albert(2), Lam Edwin(2)
Affiliation :
(1)Department of Rehabilitation, Kowloon Hospital (2)Department of Orthopaedics & Traumatology, United Christian Hospital
Introduction :
With an aging population, the occurrence of hip fracture will predictably increase significantly. Hip fracture has been associated with increased mortality and morbidity. Moreover, it causes high economic burden on the healthcare system because of the long hospital stay and comorbidities. Bisphosphonates and denosumab are widely used for the treatment of osteoporosis.
Objectives :
The purpose of this study was to analyse the osteoporosis treatment status of patients who underwent hip operation for an osteoporotic hip fracture and compare subsequent fractures and the 5 -year survival rates of patients who received the anti-resorptive medications with those who did not receive or prematurely discontinued the anti-resorptive medications.
Methodology :
A retrospective review was performed on patients who underwent hip operation in United Christian Hospital for hip fracture and were transferred to Kowloon Hospital Department of Rehabilitation for management and rehabilitation during the period July 2013 to September 2013.
Result & Outcome :
A total of 82 cases were reviewed. Patients had non-fragility fracture (n=1), suffered from secondary osteoporosis (n=1), diagnosed malignancy (n=4), non-naïve to osteoporosis treatment before hip fracture (n=3), died in rehabilitation period (n=1), incomplete rehabilitation training (n=16) and lost follow-up (n=1) were excluded.
55 patients (female 69%, male 31%) completed the rehabilitation training were included into the analysis. Among those 55 patients, 16 patients (29%; age 70-89, mean age 80.2) were prescribed anti-resorptive medications (bisphosphonates or denosumab) continuously after hip fracture for 5 years. For the remaining 39 patients (71%; age 68-94, mean age 82.2), 28 of them did not receive anti-resorptive medications after hip fracture and 11 of them discontinued anti-resorptive medications within 5 years.
Patients who were treated with anti-resorptive medications continuously after hip fracture showed a trend of lower subsequent fracture rates (12.5% vs 20.5%; p=0.484) and higher 5 years survival rates (75% vs 53.8%; p=0.146).
In conclusion, 29% of elderly patients who underwent hip operation for osteoporotic hip fracture were treated with anti-resorptive medications (bisphosphonates or denosumab). This review showed that those patients who were treated with anti-resorptive medications after hip fracture had a trend of lower subsequent fracture rate and longer survival than patients without treatment. Further larger studies are needed to verify the findings despite it had already highlighted the importance of anti-resorptive treatment after osteoporotic hip fracture.
