Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-06-07T01:19:52.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a Care Pathway in the Initiation of Calcium and Vitamin D Treatment of Patients after Hip Fracture

Published online by Cambridge University Press:  01 March 2009

Richard G. Crilly ,
Mark Speechley ,
Tom J. Overend ,
Rob Mackenzie ,
Sylvia Simon  and
Shirra Cremer
Richard G. Crilly*
Affiliation:
Faculty of Medicine, University of Western Ontario
Mark Speechley
Affiliation:
Department of Epidemiology & Biostatistics, University of Western Ontario
Tom J. Overend
Affiliation:
School of Physical Therapy, Elborn College, University of Western Ontario
Rob Mackenzie
Affiliation:
Geriatric Rehabilitation Unit, Parkwood Hospital, London, ON
Sylvia Simon
Affiliation:
London Health Services Center, University Hospital, London, ON
Shirra Cremer
Affiliation:
Department of Epidemiology & Biostatistics, University of Western Ontario
*
*Request for offprints should be sent to:Dr. Richard Crilly Division of Geriatric Medicine, Parkwood Hospital 801 Commissioners Road East London, Ontario, Canada N6C 5J1 Telephone: 519-685-4021 E-mail: rcrilly@uwo.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Hip fractures, fragility fractures, indicate an increased risk for further fragility fractures. Although the way to define osteoporosis, requiring antiresorptive therapy, is not clear, all patients who have had hip fractures should be prescribed calcium and vitamin D at a minimum. In a retrospective chart review, we have explored the effectiveness of incorporating a standing recommendation (but not a standing order) for calcium and vitamin D treatment in a hip fracture care pathway, comparing units where the pathway had been implemented with those where it had not yet been started. The pathway resulted in significantly more initiation of calcium and vitamin D compared to patients not on the pathway (72% vs. 13.5%, p < 0.01). However, a follow-up study after four years showed a marked decline in the frequency of the initiation of calcium and vitamin D, suggesting the need for ongoing encouragement for the intervention to continue to be successful.

Résumé

Les fractures de la hanche sont des fractures de fragilité, et la présence de ce type de fractures augmente les risques d'en subir d'autres. Bien que la manière de définir l'ostéoporose, qui requière des traitements antirésorption, chez les patients qui ont subi une fracture de la hanche n'est pas très claire, ces derniers devraient minimalement se faire prescrire du calcium et de la vitamine D. Lors d'un examen rétrospectif des dossiers, nous avons étudié l'efficacité d'inclure une recommandation (et non un règlement) sur la prise de calcium et de vitamine D au plan d'intervention concernant les fractures de la hanche, en comparant les unités où cette façon de faire a été implantée avec celles qui ne l'ont pas encore mise en place. Il résulte de ce plan d'intervention un nombre plus important de prescriptions de calcium et de vitamine D comparativement aux unités qui ne suivent pas ce plan (72% contre 13,5% ; p<0,01). Cependant, une étude prospective a démontré après quatre ans un déclin marqué dans la fréquence des prescriptions de calcium et de vitamine D. Cela suggère la nécessité d'un encouragement constant pour que les interventions continuent d'obtenir du succès.

Keywords

vieillissementfracture de la hancheplan d'interventionévaluationcalciumvitamine Daginghip fracturecare pathwayevaluationcalciumvitamin D
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 28 , Issue 1 , March 2009 , pp. 21 - 26
Copyright
Copyright © Canadian Association on Gerontology 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Avenell, A., Gillespie, W.J., Gillespie, L.D., & O’Connell, D.L. (2005). Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. [update of Cochrane database syst rev. 2001;(1):CD000227; PMID: 11279685]. Cochrane Database System Review, 000227.Google Scholar
Bischoff-Ferrari, H.A., Dawson-Hughes, B., Willett, W.C., Staehelin, H.B., Bazemore, M.G., Zee, R.Y., & Wong, J.B. (2004). Effect of vitamin D on falls: A meta-analysis. Journal of the American Medical Association, 291(16), 1999–2006.Google Scholar
Bischoff-Ferrari, H.A., Willett, W.C., Wong, J.B., Giovannucci, E., Dietrich, T., & Dawson-Hughes, B. (2005). Fracture prevention with vitamin D supplementation: A meta-analysis of randomized controlled trials. Journal of the American Medical Association, 293, 2257–2264.CrossRefGoogle ScholarPubMed
Brown, J.P. & Josse, R.G. (2002). Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. [see comment][erratum appears in Canadian Medical Association Journal 2003, February 18, 168(4), 400]. Canadian Medical Association Journal, 167, S1–34.Google ScholarPubMed
Byszewski, A.M., Cranney, A., Man-Son-Hing, M., Azad, N., & Amos, S. (2006, May–June). Evaluation of in-hospital management of fracture risk in older patients: A chart review study of tertiary prevention. Archives of Gerontology and Geriatrics, 42(3), 319–328. Epub October 5, 2005.CrossRefGoogle ScholarPubMed
Chiu, K.Y., Pun, W.K., Luk, K.D.K., & Chow, S.P. (1992). Sequential fractures of both hips in elderly patients – A prospective study. Journal of Trauma, 32, 584–587.CrossRefGoogle ScholarPubMed
Clowes, J.A., Peel, N.F., & Eastell, R. (2004). The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: A randomized controlled trial. Journal of Clinical Endocrinology and Metabolism, 89, 1117–1123.CrossRefGoogle ScholarPubMed
Cramer, J.A., Amonkar, M.M., Hebborn, A., & Altman, R. (2005). Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Current Medical Research and Opinion, 21, 1453–1460.CrossRefGoogle ScholarPubMed
Crilly, R.G., Kloseck, M., & Nassur, R. (2006, June 2–6). Defining osteoporosis in hip fracture patients. Abstract P551SU, IOF World Congress on Osteoporosis.Google Scholar
Eastell, R., Reid, D.M., Compston, J., Cooper, C., Fogelman, I., Francis, R.M., et al. . (2001). Secondary prevention of osteoporosis: When should a non-vertebral fracture be a trigger for action? Quarterly Journal of Medicine, 94, 575–597.Google Scholar
Elliot-Gibson, V., Bogoch, E.R., Jamal, S.A., Beaton, D.E. (2004). Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: A systematic review. Osteoporosis International, 15, 767–778.CrossRefGoogle ScholarPubMed
Glowacki, J., LeBoff, M.S., Kolatkar, N.S., Thornhill, T.S., & Harris, M.B. (2008, May 12). Importance of vitamin D in hospital-based fracture care pathways. Journal of Nutrition and Aging, 5, 291–293.Google Scholar
Jones, T.J., Petrella, R.J., & Crilly, R. (2008). Determinants of persistence with weekly bisphosphonates in patients with osteoporosis. Journal of Rheumatology, 35, 1865–1873.Google ScholarPubMed
Lorrain, J., Paiement, G., Chevrier, N., LaLumiere, G., Laflamme, G.H., Caron, P., et al. . (2003, June 10). Population demographics and socioeconomic impact of osteoporotic fractures in Canada. Menopause, 228–234.CrossRefGoogle ScholarPubMed
Lyles, K.W., Colón-Emeric, C.S., Magaziner (Medline), J.S., Adachi, J.D., Pieper, C.F., Mautalen, C., et al. . (2007). Zoledronic acid and clinical fractures and mortality after hip fracture. New England Journal of Medicine, 357, 1799–1809.CrossRefGoogle ScholarPubMed
Majumdar, S.R., Beaupre, L.A., Harley, C.H., Hanley, D.A., Lier, D.A., Juby, A.G., et al. . (2007, October 22). Use of a case manager to improve osteoporosis treatment after hip fracture: Results of a randomized controlled trial. Archives of Internal Medicine, 167(19), 2110–2115.CrossRefGoogle ScholarPubMed
McClung, M.R., Geusens, P., Miller, P.D., Zippel, H., Bensen, W.G., Roux, C., et al. . (2001). Effect of risedronate on the risk of hip fracture in elderly women. New England Journal of Medicine, 344, 333–340.Google Scholar
Olsson, L.E., Karlsson, J., & Ekman, I. (2006). The integrated care pathway reduced the number of hospital days by half: A prospective comparative study of patients with acute hip fracture. Journal of Orthopaedic Surgery and Research; 1, 3.CrossRefGoogle ScholarPubMed
Pearse, E.O., Redfern, D.J., Sinha, M., & Edge, A.J. (2003). Outcome following a second hip fracture. Injury, 34(7), 518–521.CrossRefGoogle ScholarPubMed
Roberts, H.C., Pickering, R.M., Onslow, E., Clancy, M., Powell, J., Roberts, A., et al. . (2004). The effectiveness of implementing a care pathway for femoral neck fracture in older people: A prospective controlled before and after study. Age and Ageing, 33, 178–184.Google Scholar
Rodan, E.J.A., Negri, A.L., & Gador, S.A. (2001). Short term compliance to daily alendronate treatment in 1,877 patients with osteoporosis – The ECMO study. Journal of Bone Mineral Research, 16, SU411.Google Scholar
Sander, B., Elliot-Gibson, V., Beaton, D.E., Bogoch, E.R., & Maetzel, A. (2008, June). A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. Journal of Bone and Joint Surgery, American Edition, 90(6), 1197–1205.Google ScholarPubMed
Wilkins, K. (1999). Medications and fall-related fractures in the elderly. Health Reports, 11, 45–53(Eng); 49–58(Fre).Google Scholar