Under treatment of osteoporosis in men after hip fracture
A recent study, Arch Inter Med 2002 Oct 28;162(19):2217-22, Under treatment of osteoporosis in men with hip fracture. Kiebzak GM and others, PMID: 12390065, found that only 4.5 % of men or 27% of women had any type of treatment for osteoporosis at hospital discharge after admission for hip fracture. These were elderly people, mean age of the men was 80 years and the women 81 years, who had fallen from standing height. The 12-month mortality was 32% in men, compared with 17% in women (P=0.003). At one to five-year follow up, 27% of the men were taking treatment of any kind for osteoporosis, compared with 71% of the women (P<0.001). Of those treated, 67% of men and 32% of women were taking calcium and vitamin D only, and only 11% of the men had a bone mineral density test compared with 27% of the women. In spite of the high mortality and post-fracture disability, the authors conclude, "Nevertheless, few men receive antiresorptive treatment."
Another British study had similar findings concerning the initial diagnosis and treatment of osteoporosis when patients reported to a clinic with low-energy hip or distal radius fractures. See Int J Clinc Pract 2002 Oct;56(8):620-1, Management of osteoporosis in an orthopaedic department: audit improves practice. Charalambous CP and others, PMID 12425375. The authors found no one was started on treatment or referred for further investigations after distal radius fracture. Sixteen percent of elderly female patients with low-energy hip fractures received treatment or a referral. The authors conclude, "After changes in our practice, 76% (p<0.00001) of patients with hip fractures and 81% (p<0.00001) of those with distal radius fractures were investigated, started on treatment or referred to a consultant physician for the management of osteoporosis."
Editor's comments: A running theme through the newsletters posted on the Men's Osteoporosis Support Group Web site is that it is important that patients educate themselves about their medical conditions, and see that they are being treated properly. Although the authors in these articles don't say it, the care received by the patients in the studies was certainly not the standard of care. Vitamin D and calcium are not adequate therapy for frank osteoporosis, which virtually every patient in this study certainly had. There is a need to educate medical practitioners who treat patients with hip fracture about osteoporosis. After a low-impact fracture, bone density testing should be done and approved osteoporosis therapy instituted if osteoporosis is diagnosed. Only testosterone (for men), HRT (for women), bisphosphonates, calcitonin, and human parathyroid are approved for treatment of osteoporosis. Calcium and vitamin D should be taken as an adjunct along with the other therapy, but they are not acceptable treatment for osteoporosis by themselves. So, if you, or someone you know, suffers a low-impact fracture, you must be certain that proper osteoporosis diagnosis, and if pertinent, proper therapy for osteoporosis is begun if your physician doesn't recommend it.