Orthopedics Research Today is a free monthly online journal that collates and summarizes the latest research about Orthopedics, including details on chronic injuries, muscoskeletal disorders, surgery, reconstruction.

Medical management of patients over 80 years admitted to orthopedic surgery for low-energy fracture.

Levasseur R, Sabatier JP, Guilcher C, Guaydier-Souquières G, Costentin-Pignol V, Jean-Jacques PY, Hulet C, Vielpeau C, Marcelli C

Rheumatology Department, Côte de Nacre Teaching Hospital, 14033 Caen, France.

OBJECTIVE: To develop a cost-effective strategy for improving osteoporosis management in patients admitted to an orthopedic surgery department for low-energy fractures. METHODS: From November 2003 to July 2004, all patients over 50 years admitted to the orthopedics department of the Caen Teaching Hospital (France) for low-energy fractures were identified and evaluated by rheumatology department physicians in the same hospital. RESULTS: During the study period, 313 patients were identified, 257 women (mean age, 79.5+/-10.2 years) and 56 men (mean age, 74.6+/-10.8 years), each with one fracture (proximal femur, 58.9%; wrist, 13%). Among them, 91 (29%) had a previous history of osteoporotic fractures. Mean bone mineral density (BMD) values were lower at the femoral neck than at the total hip or lumbar spine (e.g. in women, -2.3+/-0.9 versus -1.8+/-1.0 and -1.4+/-1.7, respectively). Osteoporosis treatment was given to 88 (28%) patients and consisted of calcium and vitamin D supplements, combined with alendronate in 32 patients. Complete loss of self-sufficiency occurred in 73 patients. Thus, 161 patients (88 with osteoporosis treatment and 73 with loss of self-sufficiency) received optimal treatment. CONCLUSION: Cooperation between the orthopedics and rheumatology departments improved the management of osteoporosis in patients with low-energy fractures. However, appropriate investigation and treatment of osteoporosis proved difficult in the oldest old and in patients with cognitive impairments.

Published 18 October 2006 in Joint Bone Spine.
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