Brief observation
Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture

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Patients and methods

We performed a retrospective chart review of all elderly (≥65 years) patients admitted with the principal diagnosis of hip fracture to the orthopedic unit at the Nassau County Medical Center (a 600-bed tertiary care, level-I trauma hospital) in Long Island, New York, from January 1, 1996, to December 31, 1998. The hospital is a major teaching affiliate of the State University of New York at Stony Brook Health Sciences Center and has residency programs in internal medicine and orthopedics, as

Results

A total of 170 patients were included in the study (Table 1). Half of the patients fractured their right hip, 49% fractured their left hip, and 1 patient fractured both hips. Nineteen (11%) patients had other associated fractures; the most common was a fractured wrist, which occurred in 7 patients. A fall was the most common cause of hip fracture (155 [91%] of cases); other causes included road traffic accidents (10 [6%]) and other trauma (5 [3%]). A prior diagnosis of osteoporosis was recorded

Discussion

The occurrence of a nontraumatic hip fracture in an older adult is almost always due to osteoporosis 22, 23. Following the first hip fracture, the rate of a second hip fracture in women increases sixfold, from 3.6 to 22 per 1,000 person-years (7). Several medications—including calcium 11, 12, 13, vitamin D 12, 13, alendronate 14, 15, 16, 17, and estrogen 18, 19—have been shown to decrease fracture risk. Nevertheless, rates of utilization of these therapies were low.

More recently, raloxifene, a

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      An Institutional Review Board waiver of individual informed consent was obtained from the UC San Diego Health System. Our first step was a literature review to identify best practices for management of osteoporosis in patients hospitalized for fragility fractures.11,19–22 We incorporated the following best-practice recommendations into our protocol4,23:

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