gms | German Medical Science

Objectives: Osteoporosis is the most common condition contributing to 95% of fractures in older patients who are hospitalized for fracture treatment. In spite severe medical and socioeconomic consequences of fragility fractures, efforts in optimizing osteoporotic treatment and prevention remain inadequate. In contrast, in patients with limited life expectancy withholding specific osteoporosis drug treatment seems to be reasonable. The threshold between under- and overtreatment is still unclear.

Methods: In 2016 we implemented a specialized fracture nurse for 18 months to improve quality of osteoporosis care. We collected prospectively patient's history, current treatment for osteoporosis and risk factors for fragility fractures using standardized protocol. Indication for treatment was discussed during the interdisciplinary ward round. Primary outcome parameter was an indication for specific osteoporosis drug treatment. We included 681 patients [mean age 82.5 y, 502 (73.7%) females].Inclusion criteria: age of 70 years or older, admission to geriatric fracture center between April 2016 and December 2018.

Results: Based on our data specific osteoporosis drug treatment was indicated in 467 (68.6%) patients. 651 (95.6%) patients received vitamin D3, and 546 (80.2%) supplementation of calcium. After adjustment only age, cognitive impairment, pre-fracture mobility, and living in a nursing home remained as independent predictors for an indication of specific osteoporosis drug treatment.

Conclusion: We found a higher rate of indications for specific osteoporosis drug treatment compared to usual treatment rates in literature. Even in some cases withholding of specific osteoporosis drug treatment seems to be reasonable, the main proportion of fragility fracture patients are undertreated. Our results could be a benchmark for the quality of osteoporosis care in older fragility fracture patients treated in a geriatric fracture center.