Hip fractures are the most frequently seen serious injuries in hospital patients. Current costs of osteoporotic hip fractures in Australia exceed $500 million annually. By 2040, an estimated 512,000 hip fractures will occur in the United States each year at a cost of $16 billion per year, and by 2050 an estimated 76.7 billion Euros in Europe. One year after fracture, approximately one-third of patients will have died, compared with an expected annual mortality of about 10% in this age group. More than 10% of survivors will be unable to return to their previous residence. Most of the remainder will have some residual pain or disability. In Australia, the total cost relating to osteoporosis has been estimated at $7.4bn per annum with clinical manifestations affecting two million people; hip fractures are projected to double by 2026 and increase fourfold by 2051.
There are currently no specific guidelines for osteoporosis investigation and therapy following a hip fracture in Australia. An evidence-based literature review suggest that there may be merit in:
- serum 25-hydroxyvitamin D level measurements given the high prevalence of hypovitaminosis D in patients presenting with hip fractures (60–80%), and their utility in monitoring the effectiveness of replacement therapy;
- treatment with calcium and vitamin D supplementation following a hip fracture due to its effectiveness in secondary prevention of osteoporotic fractures and in the rehabilitation process following hip fracture surgery due to improvements in proximal (shoulder, hip) muscle weakness, pain, dynamic balance and performance speed.
- treatment with of oral and intravenous bisphosphonates in selected patients due its effectiveness in secondary prevention of osteoporotic fractures and reduction in mortality (for intravenous zoledronic acid).
Low rates of osteoporotic treatment following hip fracture have previously been documented in several other Australian settings.As the risk of sustaining a second hip fracture is high during the first 12 months following the first, preventive strategies aimed at immediate effects are warranted. Systems providing specific advice with an inpatient protocol24 or involving a specific fracture clinic assessment have shown encouraging results in hip fracture patients. Our aim is to determine the benefits of an integrated programme (ICHIBAN (‘Improving the Care of HIp fractured patients at BANkstown hospital’)) to improve this treatment gap at our institution.
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