Evaluation of in-hospital management of fracture risk in older patients: A chart review study of tertiary prevention

Hip fractures are associated with considerable morbidity and mortality in the elderly. Both fall prevention strategies and bone integrity/osteoporosis assessment should be addressed in this population. This study's goal was to evaluate the management of potential re-fracture risk after a hip fracture in an acute care setting. This was a retrospective chart review of patients who were admitted with a hip fracture over the course of one year to the Ottawa Hospital, Civic Campus, Ottawa, Canada. The charts of 147 patients with hip fractures met the inclusion criteria. Use of sedatives on admission was significant (24.5%). Fifty (34%) had some form of osteoporosis management ordered during their hospital stay. The medication recommendations consisted of only 14% being prescribed Vitamin D and 15.6% being prescribed calcium supplementation. Merely 7 (4.8%) patients of the total sample were prescribed bisphosphonates at time of discharge. This study documents a significant care gap in re-fracture management at the time of acute hospitalization after an acute hip fracture. Interventions are required to increase the awareness that this problem is not being addressed at the time of hospitalization and that on discharge, patients will need follow-up by the treating community physician.