Sat., 10/20/07 Geriatrics/Injury Prevention, Paper #48, 9:12 am OTA-2007
Revisiting a Protocol for Osteoporosis Diagnosis and Treatment in Hospitalized
Orthopaedic Trauma Patients: Risk Factors and Success in Implementing Treatment
Laura Gehrig, MD1 (*); Cory Collinge, MD2 (*);
1Louisiana State University-Shreveport Medical Center, Shreveport, Louisiana, USA;
2Harris Methodist Hospital-Fort Worth/John Peter Smith Orthopedic Surgery Residency,
Fort Worth, Texas, USA
Purpose: Our goal is to redefine an algorithm for diagnosis and treatment of osteoporosis for the inpatient orthopaedic trauma service at a busy trauma center. We also identify risk factors for osteoporosis in this patient population and the success of this program in influencing ongoing osteoporosis treatment in this population.
Methods: After IRB approval, all patients treated for acute injury by a fellowship-trained orthopaedic trauma surgeon (senior author) at our trauma center were identified from a prospectively designed orthopaedic database. Patients were evaluated and treated over a 6-month period after establishment of an “osteoporosis protocol.” This protocol included: a validated bone density test (Achilles InSight®, General Electric) administered at the bedside within 36 hours of admission; prospective data collection regarding medical, osteoporosis, ovarian, nutritional, and family histories; current injuries and mechanism; and T-scores. For patients screening positive for osteoporosis (T-score <-1.6), intervention was initiated with (1) patient education, (2) initiation of calcium supplement therapy (Os-Cal D® 500 mg po BID) in the hospital with a prescription upon discharge, and (3) referral to the patient’s primary care physician with a copy of their test results for discussions on further treatments. Data were analyzed to determine risk factors for osteoporosis. At 12 months, patients with osteoporosis were contacted to assess whether they followed up with their primary care physician, and if/what osteoporosis treatments were ongoing.
Results: Complete data were available for 250 patients; there were 135 males and 115 females with an average age of 46 years (range, 18-93 years). Osteoporosis (72) or osteopenia (35) was found in 107 patients (43%). Risk factors for osteoporosis demonstrated in this series included age, female sex, cessation of ovarian function, low-energy injury, low body mass index (P <0.05). A history of cancer showed a trend toward osteoporosis (P <0.08). Odds ratios are presented. Factors not associated with osteoporosis included smoking, alcohol abuse, family history of diabetes, prior fractures, and number of fractures. At 12 months, six patients with osteoporosis had died and three were not available. Of the remaining 63 patients with osteoporosis, 36 (57%) continued to be treated for osteoporosis with, 23 patients receiving bisphosphonates and taking daily calcium/vitamin D supplements.
Conclusions and Significance: Optimal management of orthopaedic trauma patients requires recognition and improvement of bone quantity and quality during and after the healing process occurs. It appears that orthopaedic trauma surgeons may relatively easily play a role in diagnosing and treating osteoporosis, which ultimately may prevent secondary fractures. Risk factors for osteoporosis in this population are defined here. Finally, the rate of follow-up and ongoing care seen at 12 months was 57%, which is higher than that seen for previous published series.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.