Abstract
Problem: There are low rates of treatment of osteoporosis following hip fractures in the elderly. Design: Controlled before-after trial of the ortho-geriatric-led ‘ICHIBAN’ program. Data were collected by a blinded observer in 2 phases: over the year before and 10-months following intervention. The data is collected from orthopaedic wards in a large metropolitan hospital.Improvement Measures: Rate of measurement: 25-hydroxyvitamin levels (25-OHD), thyroid-stimulating hormone (TSH), and parathyroid hormone (PTH). Prescription of osteoporosis medications (vitamin D, calcium supplements, oral bisphosphonates). Documentation of rationale for non-prescription.Conclusion: Three-hundred-and-fifty-two patients presented during a period of 22-months: 202 during 12-months prior to and 150 in the 10 months following intervention. Investigation of 25-hydroxyvitamin levels increased from 31.6% to 71.2%, focused tests for secondary osteoporosis (TSH, PTH) from 9.4% to 37.1%, prescription of osteoporosis medications improved from 40.1% to 78.2% for vitamin D, 41.3% to 75.6% for calcium supplements and 34.8% to 53.8% for oral bisphosphonates (p < 0.001). Ninety percent documented rationale for non-prescription of treatment. A 6-month follow-up of the first 60 patients following intervention showed that 51.6% were still on appropriate treatment. The ICHIBAN program has improved delivery of osteoporosis care to appropriate at-risk patients following hip fracture.