Hip Fractures in Malta: Are we Missing an Opportunity?

Francesco Galea,Ivan Esposito,Gregory Apap Bologna,Daniel Desira,Mark Bugeja,Arthur Curmi

doi:10.1055/s-0041-1731635

Abstract

Introduction Osteoporosis is a bone disease that is both preventable and treatable. It usually becomes evident when a fragility fracture occurs. Unfortunately, most studies show that only a small percentage of individuals at increased risk of fracture are assessed and treated, even following a fragility fracture. Objective The aim of this study was to determine whether patients suffering from a low-energy hip fractures in the Maltese Islands are given osteoporosis treatment. Method All patients older than 50 years presenting to the acute care hospitals in Malta and Gozo with a fragility hip fracture during December 1, 2015 and November 30, 2016 were included. Data on mortality, other fragility fractures, prescription of calcium, vitamin D, and antiresorptive therapy were collected. Results Calcium with vitamin D supplements were prescribed to 40% of patients; however, only 2.64% of patients were given pharmacological therapy. Following a hip fracture, the mortality rate was 18.5% at 1 year and 26.21% at 2 years. Apart from a high mortality rate, 28.19% of individuals sustained another fragility fracture before or after the hip fracture. Conclusion There should be increased osteoporosis awareness in Malta and a national bone mineral density screening program should be set up. An active role of the orthogeriatrics team in the management and treatment of osteoporosis following a fragility fracture might improve treatment rate and decrease refracture and mortality rates.

Highlights

Osteoporosis is a bone disease that is both preventable and treatable
At the consensus development conference in 1990, osteoporosis was defined as “a disease characterized by low bone mass, microarchitectural deterioration of bone tissue leading to enhanced bone fragility, and a consequent increase in fracture risk.”[1]. It is referred to as a “silent disease,” as it is usually asymptomatic, and becomes evident when a fragility fracture occurs.[2,3,4,5]
These fragility fractures occur in the lumbosacral spine, distal radius, hip, and proximal humerus

Summary

Methods

All individuals older than 50 years presenting to the acute care hospitals in Malta and Gozo with low-trauma hip fractures during December 1, 2015 and November 30, 2016 were included in this study. They were identified retrospectively using the hospitals’ imaging software, Picture Archiving and Communication System. Using the hospitals’ electronic case summary software, the list of medications on discharge from both the acute hospitals and the rehabilitation hospital was obtained. From the drug history on the discharge summary, those prescribed calcium, vitamin D, and antiresorptive therapy were noted. Patients’ demographics, date deceased, and length of hospital stay were obtained using the hospitals’ i. The in-hospital, 1-year, and 2-year mortality following the hip fracture was calculated

Results

Discussion

Conclusion