Telecarers help improve osteoporosis treatment, compliance in older hip fracture patients

Telecarers are beneficial in the monitoring of older hip fracture patients who are undergoing osteoporosis treatment, suggests a Singapore study. However, patient or family rejection and physician failure to prescribe persist as limitations of treatment.

“Because of the significant proportion of patients with hip fracture entering a nursing home, strategies to identify patients in this population that may continue to benefit from osteoporosis treatment are needed,” the researchers said.

Hip fracture patients at Changi General Hospital in Singapore from January 2017 to January 2018 were automatically enrolled into the Health Management Unit valued care hip fracture program. Telecarer calls were scheduled at discharge, 3, 6, and 12 months. The researchers then evaluated the acceptability, completion, and treatment rates of the participants.

Over a year, a total of 537 hip fracture patients (mean age 79.8 years, 63.1 percent female) were enrolled in the telecarer program. Some 341 patients completed the 12-month follow-up, of which 251 (73.6 percent) remained on treatment at 12 months. [Singapore Med J 2023;64:244-248]

“Those who persisted and completed the telecarer program showed high rates of commencement of antiosteoporosis medications,” the researchers said, noting a significant improvement from previous institution data, which showed a treatment rate of 31.5 percent in patients >65 years old with a fragility hip fracture at 1 year. [Arch Osteoporos 2017;12:60]

“In this regard, our pilot program was successful in increasing antiosteoporosis treatment rates 1 year after hip fracture compared with our previous institutional data,” they pointed out.

Among patients who did not initiate secondary osteoporosis treatment at 12 months, the most common cause was patient or family rejection (34.4 percent), followed by the failure of physician to prescribe (24.4 percent) and renal impairment (24.4 percent).

“These data also demonstrate the multiple challenges that lie in the utility of telemedicine in the secondary prevention of osteoporosis in our population with fragility hip fracture,” the researchers said.

“First is the high mortality and morbidity that develop after a hip fracture, with up to 20 percent of the total patients with initial hip fracture dying within 1 year or having to enter nursing homes; these patients account for most of those who failed to complete the … follow-up in our study,” they noted.

Notably, 16.7 percent of patients were identified to have advanced dementia with a life-limiting illness. Because of this, they were deemed unfit for treatment.

In addition, 31.1 percent of hip fracture patients entered nursing home residential care. However, evidence on the efficacy of osteoporosis treatment in this population are lacking, with few nursing home patients included in the trials of these medications. [Arch Intern Med 2008;168:1111-1115]

In a previous study, evidence showed gains in bone mineral density from osteoporosis treatment among women in long-term care facilities who are still ambulatory. [Ann Intern Med 2002;136:742-746]

“We propose that strategies should be implemented to identify nursing home patients who are still ambulatory and who may benefit from osteoporosis treatment. These may include liaising with the nursing home physician and educating the patients on the evidence and benefits of these treatments,” the researchers said.

“Further studies should focus on a combination of interventions for both patients and physicians to increase awareness of secondary fracture prevention,” they added.