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The Treatment Gap in Fragility Hip Fractures in Saskatoon

By: Scott Willms

Introduction: According to the 2010 Canadian Osteoporotic guidelines, there is strong evidence to suggest that patients greater than the age of 50 with prior fragility hip fractures should be treated with anti-osteoporotic medication. These guidelines also suggest that despite this evidence, less that 20% of these people are on the medications they need to be on to prevent further fractures. This study was designed to discover what the actual treatment gap is for the hip fractures seen in Saskatoon as the beginning phase of a quality improvement project.

Methods: The current use of anti-osteoporosis medication post fragility hip fracture was assessed during the time period of January to June 2017. This consisted of 242 patients, all who 50 years of age or older, and had a fragility hip fracture. Various data was collected including pre- and post-fracture anti-osteoporotic medication prescription and a prior fracture history during a retrospective chart review performed in August 2018.

Results: Only 14% of patients were on an anti-osteoporotic medication post hip fracture. When patients who were on medication prior to the fracture were excluded, this number dropped to 6%. It was determined that 15% of patients had a prior indication to be on a medication while another 7% had prior warning signs that they should have been evaluated for osteoporosis prior to the fracture.

Conclusion: Saskatoon is no different, if not worse, than the rest of Canada when it comes to treating post hip fragility fractures with anti-osteoporotic medication despite the good evidence in support of this. This leaves a lot of room for improvement and further work including initiating an automated referral process to a fracture liaison service with our Rheumatology colleagues has been completed to ensure that the standard of care is risen. Future work will include studying the effects of this change.

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