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Undertreatment of Osteoporosis in Men Who Have Had a Hip Fracture

Undertreatment of Osteoporosis in Men Who Have Had a Hip Fracture Kiebzak et al1 should be congratulated on their efforts to highlight the undertreatment of osteoporosis in men who have had a hip fracture. Methodological constraints due to the retrospective collection of data are evident, particularly on their assessment of comorbidity and risk factors. But the poor rates of prefracture and postfracture osteoporosis treatment, particularly in men, will make for uncomfortable reading among orthopedic surgeons across the globe. These patients are often seen by orthopedic services on multiple occasions. Robinson et al2 have prospectively studied the rates of refracture in individuals who had previously experienced wrist, proximal humerus, ankle, or hip insufficiency fractures. Men older than 45 years were shown to be at significantly higher risk of insufficiency fractures compared with women (relative risk, 5.55 [men] vs 2.94 [women]). Interestingly, this increased risk was sustained in all age group cohorts from 45 to 85 years or older. Previous hip, wrist, and proximal humerus fractures all predisposed to subsequent hip fracture. Conversely, a previous hip fracture was also shown to be a risk factor for subsequent wrist, hip, or proximal humerus fracture. These findings indicate that those patients with hip fractures, and indeed other insufficiency fractures, are likely to require orthopedic surgical management for more than just the index injury. Osteoporosis treatment for the patient at risk is therefore an option that the orthopedic surgeon cannot safely ignore. The reluctance to institute fracture prevention pharmaceutical regimens is likely to be symptomatic of the paucity of evidence for their efficacy, particularly in the older insufficiency fracture population.3,4 Until the efficacy of bisphosphonates, calcium, vitamin D, and other agents in fracture prevention is clearly demonstrated in elderly patients, the findings of undertreatment by Kiebzak et al1 will remain prevalent. References 1. Kiebzak GMBeinart GAPerser KAmbrose CGSift SJHeggeness MH Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002;1622217- 2222Google ScholarCrossref 2. Robinson CMRoyds MAbraham ACourt-Brown CMChristie J Refractures in patients at least forty-five years old: a prospective analysis of twenty-two thousand and sixty patients. J Bone Joint Surg Am. 2002;841528- 1533Google ScholarCrossref 3. Gillespie WJAvenell AHenry DAO'Connell DLRobertson J Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis [Cochrane Review on CD-ROM]. Oxford, England Cochrane Library, Update Software2003; (issue 1) Available at: http://www.update-software.com/abstracts/ab000227.htm. Accessed January 4, 2003. 4. Cranney AWelch VAdachi JD et al. Etidronate for treating and preventing postmenopausal osteoporosis [Cochrane Review on CD-ROM]. Oxford, England Cochrane Library, Update Software2003; (issue 1) Available at: http://www.update-software.com/abstracts/ab003376.htm. Accessed January 4, 2003. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Undertreatment of Osteoporosis in Men Who Have Had a Hip Fracture

Archives of Internal Medicine , Volume 163 (10) – May 26, 2003

Undertreatment of Osteoporosis in Men Who Have Had a Hip Fracture

Abstract

Kiebzak et al1 should be congratulated on their efforts to highlight the undertreatment of osteoporosis in men who have had a hip fracture. Methodological constraints due to the retrospective collection of data are evident, particularly on their assessment of comorbidity and risk factors. But the poor rates of prefracture and postfracture osteoporosis treatment, particularly in men, will make for uncomfortable reading among orthopedic surgeons across the globe. These patients are often seen...
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Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.163.10.1236-a
Publisher site
See Article on Publisher Site

Abstract

Kiebzak et al1 should be congratulated on their efforts to highlight the undertreatment of osteoporosis in men who have had a hip fracture. Methodological constraints due to the retrospective collection of data are evident, particularly on their assessment of comorbidity and risk factors. But the poor rates of prefracture and postfracture osteoporosis treatment, particularly in men, will make for uncomfortable reading among orthopedic surgeons across the globe. These patients are often seen by orthopedic services on multiple occasions. Robinson et al2 have prospectively studied the rates of refracture in individuals who had previously experienced wrist, proximal humerus, ankle, or hip insufficiency fractures. Men older than 45 years were shown to be at significantly higher risk of insufficiency fractures compared with women (relative risk, 5.55 [men] vs 2.94 [women]). Interestingly, this increased risk was sustained in all age group cohorts from 45 to 85 years or older. Previous hip, wrist, and proximal humerus fractures all predisposed to subsequent hip fracture. Conversely, a previous hip fracture was also shown to be a risk factor for subsequent wrist, hip, or proximal humerus fracture. These findings indicate that those patients with hip fractures, and indeed other insufficiency fractures, are likely to require orthopedic surgical management for more than just the index injury. Osteoporosis treatment for the patient at risk is therefore an option that the orthopedic surgeon cannot safely ignore. The reluctance to institute fracture prevention pharmaceutical regimens is likely to be symptomatic of the paucity of evidence for their efficacy, particularly in the older insufficiency fracture population.3,4 Until the efficacy of bisphosphonates, calcium, vitamin D, and other agents in fracture prevention is clearly demonstrated in elderly patients, the findings of undertreatment by Kiebzak et al1 will remain prevalent. References 1. Kiebzak GMBeinart GAPerser KAmbrose CGSift SJHeggeness MH Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002;1622217- 2222Google ScholarCrossref 2. Robinson CMRoyds MAbraham ACourt-Brown CMChristie J Refractures in patients at least forty-five years old: a prospective analysis of twenty-two thousand and sixty patients. J Bone Joint Surg Am. 2002;841528- 1533Google ScholarCrossref 3. Gillespie WJAvenell AHenry DAO'Connell DLRobertson J Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis [Cochrane Review on CD-ROM]. Oxford, England Cochrane Library, Update Software2003; (issue 1) Available at: http://www.update-software.com/abstracts/ab000227.htm. Accessed January 4, 2003. 4. Cranney AWelch VAdachi JD et al. Etidronate for treating and preventing postmenopausal osteoporosis [Cochrane Review on CD-ROM]. Oxford, England Cochrane Library, Update Software2003; (issue 1) Available at: http://www.update-software.com/abstracts/ab003376.htm. Accessed January 4, 2003.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 26, 2003

Keywords: osteoporosis,hip fractures

References

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