Abstract
Summary
A poorer functional status at the time of fracture is a predictor of non-adherence to oral bisphosphonates initiated after a hip fracture, and suggests further opportunities for optimization of secondary fracture prevention in this high-risk population.
Introduction
Low adherence to treatment is a problem in post-fracture secondary prevention. We aimed to analyze the prognostic factors (related and predictive) associated with non-adherence to oral bisphosphonate prescription for hip fracture due to bone fragility (HFBF) 12 months after discharge from an acute geriatric unit.
Methods
Prospective study of bivariate data analyzing related and multivariate factors predicting non-adherence of oral bisphosphonates at 12 months after treatment for HFBF. The statistical study was performed with SPSS 19.0.0.
Results
We attended 368 patients with HFBF. At discharge, oral bisphosphonates were prescribed to 226 (61.42%) patients. At 12 months, we followed up 160 (70.7%) patients, 104 (65%) of whom had non-adherence to oral bisphosphonates. Bivariate analysis (adherent vs. non-adherent): age (83.79 ± 5.82 vs. 85.78 ± 5.80, p = .029); Lawton and Brody Index (4.29 ± 3.40 vs. 2.67 ± 3.31, p = .004); baseline Barthel Index (BI) (85.89 ± 21.99 vs. 74.18 ± 26.70) (p = .004); BI at admission (18.84 ± 10.00 vs. 14.47 ± 11.71, p = .004); BI at discharge (34.20 ± 15.40 vs. 27.45 ± 16.71, p = .011); baseline Functional Ambulation Classification (5.66 ± 0.98 vs. 5.43 ± 0.99, p = .025). Multivariate analysis: BI 0.980 (0.965–0.995, p = .007). Discriminatory capacity of the AUC model (± 95% CI): 0.634 (0.545–0.722).
Conclusions
At 12 months, there was low adherence to treatment with oral bisphosphonates in our model. A lower BI prior to treatment is a predictive factor for non-adherence treatment with oral bisphosphonate.
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References
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet (London, England) 359(9319):1761–1767
Ross S, Samuels E, Gairy K, Iqbal S, Badamgarav E, Siris E. A meta-analysis of osteoporotic fracture risk with medication nonadherence. Value Health 2011;14(4):571–581. Available from: https://doi.org/10.1016/j.jval.2010.11.010
Lee YK, Ha YC, Yoon BH, Koo KH (2013) Incidence of second hip fracture and compliant use of bisphosphonate. Osteoporos Int 24(7):2099–2104
Kim S-M, Moon Y-W, Lim S-J, Yoon B-K, Min Y-K, Lee D-Y, Park YS (2012) Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 50(6):1343–1350
Smith T, Pelpola K, Ball M, Ong A, Myint PK (2014) Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 43(4):464–471
Mears SC, Kates SL (2015) A guide to improving the Care of Patients with fragility fractures, edition 2. Geriatr Orthop Surg Rehabil 6(2):58–120 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26246957%5Cn http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4430408
Nanjayan SK, John J, Swamy G, Mitsiou K, Tambe A, Abuzakuk T. Predictors of change in “discharge destination” following treatment for fracture neck of femur. Injury 2014;45(7):1080–1084. Available from: https://doi.org/10.1016/j.injury.2014.02.005
Tarazona-Santabalbina FJ, Belenguer-Varea Á, Rovira E, Cuesta-Peredó D (2016) Orthogeriatric care: improving patient outcomes. Clin Interv Aging 11:843–856. https://doi.org/10.2147/CIA.S72436
Cenzer IS, Tang V, Boscardin WJ, Smith AK, Ritchie C, Wallhagen MI, Espaldon R, Covinsky KE (2016) One-year mortality after hip fracture: development and validation of a prognostic index. J Am Geriatr Soc 64:1863–1868
Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, et al. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet. 2015;385(9978):1623–1633. Available from: https://doi.org/10.1016/S0140-6736(14)62409-0
Henderson CY, Shanahan E, Butler A, Lenehan B, O’Connor M, Lyons D et al (2016) Dedicated orthogeriatric service reduces hip fracture mortality. Ir J Med Sci:1–6
Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado MT, Murga V, Gamboa A, Rodriguez C, Castellà J, Escalante E, Lumbreras C, Tarrida A, Sellarès R (2018) Advantages of care for patients with hip fractures in the acute geriatric unit: hip study Anoia. Geriatr Gerontol Int 18(3):407–414
Herrera M, Rodriguez E, Alvisa J, JL P (2013) Listado de comprobación al alta en la prevención de nuevas fracturas osteoporóticas de cadera. Rev Osteoporos Metab Min 5(1):7–14
Nogués X, Martinez-Laguna D. Tratamiento de la osteoporosis. Med Clin (Barc). 2017;(xx). Available from: https://doi.org/10.1016/j.medcli.2017.10.019
Cosman F (2009) Treatment of osteoporosis and prevention of new fractures: role of intravenously administered bisphosphonates. Endocr Pract 15(5):483–493
Kim SC, Kim M, Song HJ, Liu J, Hurtado I, Lee J et al (2016) Fracture: a Cross-National Study. 128(5):519–526
Flais J, Coiffier G, Le Noach J, Albert JD, Faccin M, Perdriger A et al (2017) Low prevalence of osteoporosis treatment in patients with recurrent major osteoporotic fracture. Arch Osteoporos 12(1):24 Available from: http://link.springer.com/10.1007/s11657-017-0317-4
Rabenda V, Vanoverloop J, Fabri V, Mertens R, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster JY (2008) Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am 90(10):2142–2148
Silverman SL, Gold DT, Cramer J (2007) a. Reduced fracture rates observed only in patients with proper persistence and compliance with bisphosphonates therapies. South Med J 100(12):1214–1218
Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65
Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186
Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L (1984) Clinical gait assessment in the neurologically impaired reliability and meaningfulness. Phys Ther 64(1):35–40
Reisberg B, Ferris SH, de Leon MJ, Crook T (1982) The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 139(9):1136–1139
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Owens WD, Felts JA, Spitznagel ELJ (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49(4):239–243
Gregory PC, Lam D, Howell P (2010) Osteoporosis treatment following hip fracture: how rates vary by service. South Med J 103(10):977–981
Hsu CY, Chiu WC, Chen JF, Chou CL, Su YJ, Yu SF, Cheng TT Medical specialty-related adherence to anti-osteoporotic regimens in fragility hip fracture patients. J Bone Miner Metab. 2014;33(5):577–583. Available from: https://doi.org/10.1007/s00774-014-0621-7
Petrella RJ, Jones TJ (2006) Do patients receive recommended treatment of osteoporosis following hip fracture in primary care? BMC Fam Pract 7:31 Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L44139182%5Cn http://www.biomedcentral.com/content/pdf/1471-2296-7- 31.pdf%5Cnhttp://dx.doi.org/10.1186/1471-2296-7-31%5Cn http://sfx.library.uu.nl/utrecht?sid=EMBASE&issn=14712296&id=d
Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 12:117–127
Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR et al (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24(2):393–406 Available from: http://link.springer.com/10.1007/s00198-012-2090-y
Naranjo A, Ojeda-Bruno S, Bilbao-Cantarero A, Quevedo-Abeledo JC, Diaz-González BV, Rodríguez-Lozano C (2015) Two-year adherence to treatment and associated factors in a fracture liaison service in Spain. Osteoporos Int 26(11):2579–2585
Folbert EC, Hegeman JH, Vermeer M, Regtuijt EM, van der Velde D, Ten Duis HJ, et al. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment. Osteoporos Int. 2016;1–9. Available from: https://doi.org/10.1007/s00198-016-3711-7
Schaller F, Sidelnikov E, Theiler R, Egli A, Staehelin HB, Dick W, Dawson-Hughes B, Grob D, Platz A, Can U, Bischoff-Ferrari HA Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture. Bone. 2012;51(3):347–352. Available from: https://doi.org/10.1016/j.bone.2012.06.004
Fukui N, Watanabe Y, Nakano T, Sawaguchi T, Matsushita T (2012) Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury: a 1-year prospective cohort study. J Orthop Trauma 26(3):163–171 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21918484
Dehamchia-Rehailia N, Ursu D, Henry-Desailly I, Fardellone P, Paccou J (2014) Secondary prevention of osteoporotic fractures: evaluation of the Amiens University Hospital’s fracture liaison service between January 2010 and December 2011. Osteoporos Int 25(10):2409–2416
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The study was performed following the principles of the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Bellvitge Hospital (PR197/13).
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Gamboa, A., Duaso, E., Marimón, P. et al. Oral bisphosphonate prescription and non-adherence at 12 months in patients with hip fractures treated in an acute geriatric unit. Osteoporos Int 29, 2309–2314 (2018). https://doi.org/10.1007/s00198-018-4622-6
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DOI: https://doi.org/10.1007/s00198-018-4622-6