Download PDF
CC BY 4.0 · Surg J (N Y) 2021; 07(03): e184-e190
DOI: 10.1055/s-0041-1731635
Original Article

Hip Fractures in Malta: Are we Missing an Opportunity?

Mark Bugeja
1   Department of Trauma and Orthopaedics, Mater Dei Hospital, Malta
,
Arthur Curmi
1   Department of Trauma and Orthopaedics, Mater Dei Hospital, Malta
,
Daniel Desira
1   Department of Trauma and Orthopaedics, Mater Dei Hospital, Malta
,
Gregory Apap Bologna
1   Department of Trauma and Orthopaedics, Mater Dei Hospital, Malta
,
Francesco Galea
1   Department of Trauma and Orthopaedics, Mater Dei Hospital, Malta
,
Ivan Esposito
1   Department of Trauma and Orthopaedics, Mater Dei Hospital, Malta
› Author Affiliations Funding The authors received no financial support for the research, authorship, and/or publication of this article.
› Further Information
   Permissions and Reprints

Abstract

Introduction Osteoporosis is a bone disease that is both preventable and treatable. It usually becomes evident when a fragility fracture occurs. Unfortunately, most studies show that only a small percentage of individuals at increased risk of fracture are assessed and treated, even following a fragility fracture.

Objective The aim of this study was to determine whether patients suffering from a low-energy hip fractures in the Maltese Islands are given osteoporosis treatment.

Method All patients older than 50 years presenting to the acute care hospitals in Malta and Gozo with a fragility hip fracture during December 1, 2015 and November 30, 2016 were included. Data on mortality, other fragility fractures, prescription of calcium, vitamin D, and antiresorptive therapy were collected.

Results Calcium with vitamin D supplements were prescribed to 40% of patients; however, only 2.64% of patients were given pharmacological therapy. Following a hip fracture, the mortality rate was 18.5% at 1 year and 26.21% at 2 years. Apart from a high mortality rate, 28.19% of individuals sustained another fragility fracture before or after the hip fracture.

Conclusion There should be increased osteoporosis awareness in Malta and a national bone mineral density screening program should be set up. An active role of the orthogeriatrics team in the management and treatment of osteoporosis following a fragility fracture might improve treatment rate and decrease refracture and mortality rates.

Keywords

hip fractures - fragility fractures - calcium - vitamin D - bisphosphonates

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.




Publication History

Received: 24 January 2020

Accepted: 14 April 2021

Article published online:
22 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Consensus development conference. Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 1991; 90 (01) 107-110
    CrossrefPubMedGoogle Scholar
  • 2 Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol 2017; 4 (01) 46-56
    CrossrefPubMedGoogle Scholar
  • 3 Larsson S, Fazzalari NL. Anti-osteoporosis therapy and fracture healing. Arch Orthop Trauma Surg 2014; 134 (02) 291-297
    CrossrefPubMedGoogle Scholar
  • 4 Cosman F, de Beur SJ, LeBoff MS. et al; National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2014; 25 (10) 2359-2381
    CrossrefPubMedGoogle Scholar
  • 5 Kling JM, Clarke BL, Sandhu NP. Osteoporosis prevention, screening, and treatment: a review. J Womens Health (Larchmt) 2014; 23 (07) 563-572
    CrossrefPubMedGoogle Scholar
  • 6 Kanis JA, Melton III LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9 (08) 1137-1141
    CrossrefPubMedGoogle Scholar
  • 7 Bugeja M, Aquilina S, Farrugia C, Esposito I. Demographic study of hip fractures in the Maltese Islands. Geriatr Orthop Surg Rehabil 2018; 9: 2151459318764772
    CrossrefPubMedGoogle Scholar
  • 8 Akkawi I, Zmerly H. Osteoporosis: current concepts. Joints 2018; 6 (02) 122-127
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Pietri M, Lucarini S. The orthopaedic treatment of fragility fractures. Clin Cases Miner Bone Metab 2007; 4 (02) 108-116 http://www.ncbi.nlm.nih.gov/pubmed/22461210. Accessed May 4, 2021
    PubMedGoogle Scholar
  • 10 Porter JL, Varacallo M. Osteoporosis . StatPearls Publishing; 2019 http://www.ncbi.nlm.nih.gov/pubmed/28722930. Accessed May 4, 2021
    PubMedGoogle Scholar
  • 11 Kim S-R, Ha Y-C, Park Y-G, Lee S-R, Koo K-H. Orthopedic surgeon's awareness can improve osteoporosis treatment following hip fracture: a prospective cohort study. J Korean Med Sci 2011; 26 (11) 1501-1507
    CrossrefPubMedGoogle Scholar
  • 12 Gonnelli S, Caffarelli C, Iolascon G. et al. Prescription of anti-osteoporosis medications after hospitalization for hip fracture: a multicentre Italian survey. Aging Clin Exp Res 2017; 29 (05) 1031-1037
    CrossrefPubMedGoogle Scholar
  • 13 Melton LJ, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective how many women have osteoporosis?. J Bone Miner Res 1992; 07 (09) 1005-1010
    CrossrefPubMedGoogle Scholar
  • 14 Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 2004; 15 (10) 767-778
    CrossrefPubMedGoogle Scholar
  • 15 Kim SC, Kim MS, Sanfélix-Gimeno G. et al. Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study. Am J Med 2015; 128 (05) 519-26.e1
    CrossrefPubMedGoogle Scholar
  • 16 Dilemmas in the management of osteoporosis. Drug Ther Bull 2015; 53 (02) 18-21
    CrossrefPubMedGoogle Scholar
  • 17 World Health Organization. (1994). Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]. World Health Organization. https://apps.who.int/iris/handle/10665/39142 . Accessed December 10, 2019
    PubMedGoogle Scholar
  • 18 Szulc P, Bouxsein ML. Overview of osteoporosis: epidemiology and clinical management. Vertebral fracture initiative resource document. 2011. Accessed December 10, 2019 from: www.iofbonehealth.org/IOF_VFI-Part_I
    PubMedGoogle Scholar
  • 19 WHO Scientific Group on The Assessment of Osteoporosis at Primary Health Care Level Summary Meeting Report.; 2004. Accessed December 10, 2019 from: https://www.who.int/chp/topics/Osteoporosis.pdf
    PubMedGoogle Scholar
  • 20 Sheu A, Diamond T. Bone mineral density: testing for osteoporosis. Aust Prescr 2016; 39 (02) 35-39
    CrossrefPubMedGoogle Scholar
  • 21 Diamond T, Tonks K. Secondary causes of osteoporosis in women: diagnoses not to be missed. Med Today (Karachi) 2008; 9 (05) 48-62
    PubMedGoogle Scholar
  • 22 Camacho PM, Petak SM, Binkley N. et al. AACE/ACE Guidelines American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for The Diagnosis and Treatment of Postmenopausal Osteoporosis-2016. Endocr Pract 2016; 22 (4, Suppl 4): 1-42
    CrossrefPubMedGoogle Scholar
  • 23 Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2019; 104 (05) 1595-1622
    CrossrefPubMedGoogle Scholar
  • 24 Compston J, Cooper A, Cooper C. et al; National Osteoporosis Guideline Group (NOGG). UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2017; 12 (01) 43 DOI: 10.1007/s11657-017-0324-5.
    CrossrefPubMedGoogle Scholar
  • 25 Sunyecz JA. The use of calcium and vitamin D in the management of osteoporosis. Ther Clin Risk Manag 2008; 4 (04) 827-836
    CrossrefPubMedGoogle Scholar
  • 26 McClung MR. Bisphosphonates in osteoporosis: recent clinical experience. Expert Opin Pharmacother 2000; 1 (02) 225-238
    CrossrefPubMedGoogle Scholar
  • 27 Dore RK. The RANKL pathway and denosumab. Rheum Dis Clin North Am 2011; 37 (03) 433-452 , vi–vii
    CrossrefPubMedGoogle Scholar
  • 28 Gennari L, Merlotti D, Nuti R. Selective estrogen receptor modulator (SERM) for the treatment of osteoporosis in postmenopausal women: focus on lasofoxifene. Clin Interv Aging 2010; 5 (01) 19-29
    CrossrefPubMedGoogle Scholar
  • 29 Miki RA, Oetgen ME, Kirk J, Insogna KL, Lindskog DM. Orthopaedic management improves the rate of early osteoporosis treatment after hip fracture. A randomized clinical trial. J Bone Joint Surg Am 2008; 90 (11) 2346-2353
    CrossrefPubMedGoogle Scholar
  • 30 de Jong MR, Van der Elst M, Hartholt KA. Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf 2013; 4 (04) 147-154
    CrossrefPubMedGoogle Scholar
  • 31 Panday K, Gona A, Humphrey MB. Medication-induced osteoporosis: screening and treatment strategies. Ther Adv Musculoskelet Dis 2014; 6 (05) 185-202
    CrossrefPubMedGoogle Scholar
  • 32 Black DM, Cummings SR, Karpf DB. et al; Fracture Intervention Trial Research Group. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996; 348 (9041): 1535-1541
    CrossrefPubMedGoogle Scholar
  • 33 Cummings SR, Black DM, Thompson DE. et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280 (24) 2077-2082
    CrossrefPubMedGoogle Scholar
  • 34 Quandt SA, Thompson DE, Schneider DL, Nevitt MC, Black DM. Fracture Intervention Trial Research Group. Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of-1.6 to -2.5 at the femoral neck: the Fracture Intervention Trial. Mayo Clin Proc 2005; 80 (03) 343-349
    CrossrefPubMedGoogle Scholar
  • 35 Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer PK, Lee SJ. Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 2010; 58 (04) 650-657
    CrossrefPubMedGoogle Scholar
  • 36 Cuschieri S, Grech S, Gatt R. Bisphosphonates: a cost benefit analysis patient. Malta Med J 2016; 28 (01) 4-11
    PubMedGoogle Scholar
  • 37 Huybrechts KF, Ishak KJ, Caro JJ. Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 2006; 38 (06) 922-928
    CrossrefPubMedGoogle Scholar
  • 38 Rabenda V, Vanoverloop J, Fabri V. et al. Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am 2008; 90 (10) 2142-2148
    CrossrefPubMedGoogle Scholar
  • 39 Lyles KW, Colón-Emeric CS, Magaziner JS. et al; HORIZON Recurrent Fracture Trial. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357 (18) 1799-1809
    CrossrefPubMedGoogle Scholar