Orthogeriatric care is associated with increased osteoporosis diagnosis and treatment in older adults with previous hip fracture, according to the findings of a systematic review and meta-analysis published in Osteoporosis International.
Orthogeriatrics has emerged as a collaborative care model between geriatricians and orthopedic surgeons for older adults hospitalized with severe fractures, including hip fractures. In a systematic review and meta-analysis, researchers aimed to determine whether orthogeriatric vs standard care for patients with hip fracture was associated with improved treatment of osteoporosis and prevention of falls and fractures.
Researchers performed a literature search of the PubMed, Web of Science, and Embase online databases from inception through April 13, 2020. References of selected articles were manually searched for additional relevant studies. Primary outcomes of interest included subsequent fall and fracture prevention, as well as the uptake of calcium and vitamin D supplements and antiosteoporosis drugs. Researchers also aimed to evaluate whether outcomes varied between different models of orthogeriatric care.
A total of 20,078 patients with hip fracture (68% women) from 13 studies (1 randomized controlled trial and 12 observational studies) were included in the analysis. The median ages of the patients ranged from 75 to 85 years. A historic control group was used in 8 of the included studies leading to potential noncontemporaneous control bias. In addition, 3 studies were at high risk for bias because they compared different orthopedic teams and healthcare organizations.
Based on the results of 2 studies, patients in orthogeriatric care were significantly more likely to receive an osteoporosis diagnosis compared with those in standard care (odds ratio [OR], 11.36; 95% CI, 7.26-17.77).
Although there was considerable heterogeneity between studies, patients in orthogeriatric vs standard care were more likely to initiate calcium and vitamin D supplementation (OR, 41.44; 95% CI, 7.07-242.91). Similar results were observed for the initiation of antiosteoarthritis drugs at discharge (OR, 7.06; 95% CI, 2.87-17.34).
Fall prevention and subsequent risk for fracture were reported in 2 studies. Overall, there was no significant difference in the 1-year refracture rates between orthogeriatric and standard care groups. There was not enough evidence available to compare outcomes between different models of orthogeriatric care.
Researchers noted that the relatively small number of studies included and the high risk for bias represented limitations of the analysis.
“[O]rthogeriatric care models appear to be positively associated with rates of osteoporosis diagnosis and treatment in older patients [with] hip fracture,” the authors of the review concluded. They acknowledged that there was considerable heterogeneity in the results observed, noting that, “the quality of evidence supporting orthogeriatrics for osteoporosis management remains low…Adequately powered [randomized controlled trials] are needed to determine if orthogeriatric care increases treatment rates and can prevent falls and fractures in patients [with] hip fracture.”
Disclosures: Several study authors reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.
Van Camp L, Dejaeger M, Tournoy J, Gielen E, Laurent MR. Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-analysis. Osteoporos Int. Published online June 27, 2020. doi:10.1007/s00198-020-05512-y