THU430 Post Discharge Treatment Practice And Outcomes Following Osteoporotic Hip Fracture - A Tertiary Care Center Experience
Authors: Vaghasia Nishit , Yin Yue , Hasan Farhad 
Published: October 2023

Disclosure: N. Vaghasia: None. Y. Yin: None. F. Hasan: None.

Introduction: Osteoporosis remains significantly undertreated. Even after osteoporotic hip fracture most patients remain untreated. Patients who sustain hip fracture have significant morbidity like subsequent fractures, loss of functional independence and high rate of readmission to hospital and also have high rate of mortality in subsequent years compared to controls. The objective of our study is to understand treatment practice and outcomes following hip fracture at a tertiary care hospital. Methods: We did a retrospective study of patients admitted between January 2016 and June 2020 with hip fracture at two tertiary care academic hospital. We included patient above 40 years of age who and previously not treated for osteoporosis. We excluded patients with traumatic fracture, advanced renal disease and active malignancy. We collected demographics like age, sex and race. Other variables like admitting and discharging team, length of hospital stay, readmission and mortality rate, referral to specialty (Endocrinology/Rheumatology) on discharge, specialty follow up after discharge, treatment initiation after discharge, preadmission and postadmission DXA scan and polypharmacy (five or more daily prescription medication) were collected. The primary objective of the study was to see the differences in treatment practice of osteoporosis fracture based on follow up with specialist versus primary care physician. Secondary objective was to see differences in outcomes like readmission and mortality based on treatment initiation and follow up with specialist. Results: Among the 421 patients reviewed, 253 met inclusion criteria. Among them 70.2% (177) were above 70 years age; 70.8% (179) were female; 94.4% (239) were Caucasian; 3.6% (9) were given referral to specialist on discharge; 8% (20) followed with specialist; 69.1% (170) were on polypharmacy; 64.3% (159) had readmission within two years and 23.6% (58) died within two years of hip fracture. Patients followed by specialist had higher chances of being treated with osteoporosis medication (70% vs. 6.9%, p&lt;0.0001) and having post fracture DXA scan (84.2% vs. 13%, p&lt;0.0001). Following specialist had higher chances of being treated within six months of fracture (40% vs. 4.3%, p&lt;0.0001). Among those presented with hip fracture only 22.8% of female ≥ 65 years and 4.2% of male ≥ 70 years had preadmission DXA scan. Patients treated after hip fracture had lower rate of readmission (56.7% vs. 65.4%) and mortality (10% vs. 25.1%) however did not reach statistical significance due to small sample size of overall patients treated. Conclusion: Our study suggest that osteoporotic hip fracture remains significantly untreated. Follow up with specialist increases one’s chance of being treated especially early on after the fracture. Our study also suggest that screening guidelines of getting DXA scan in both female and male is significantly neglected.

Presentation: Thursday, June 15, 2023