Introduction: Most hip fracture patients are not investigated or treated for osteoporosis despite the vast availability of bone protection medications (BPM) for secondary hip fracture prevention. The compliance to pharmacological therapies has also shown to be suboptimal.
Objectives: The objectives of this study were to identify if patients were assessed for osteoporosis post hip fracture and the compliance of BPM during short-term follow up.
Methods: Our study was a prospective study on consecutive patients aged 65 years old and above admitted to the orthopaedic ward in University of Malaya Medical Centre with acute hip fracture from March 2016 to March 2017. Data collected included baseline socio-demographic details, use of osteoporosis medication prior to admission, comorbidities, inpatient assessment of BPM and compliance to BPM 3-month post-discharge. Compliance to BPM was identified through pharmacy prescription from the hospital electronic medical records.
Results: A total of 200 patients with mean age of 81.55 (SD7.054) years old were recruited. 67.9% of patients were female and majority (57.1%) were of Chinese ethnicity. Only 8.5% of patients were diagnosed with osteoporosis previously and less than half were on BPM on admission. 43.6% were started on BPM, 10.2% were assessed and no BPM was required and 26% were not assessed. Inpatient prescription includes calcium supplements (51%), vitamin D (66%), bisphosphonates (9.5%) and injectables (2.5%). During 3-month follow up, there was low adherence to all medications with non-compliance rate of 53.9%, 56.1%, 36.8% and 20% respectively. Male gender, non-Chinese ethnicity, not being discharged to home and naive users of BPM were associated with higher risk of non-compliance to BPM.
Conclusion: There is a huge care gap in the management of secondary prevention post hip fracture in our population. A systematic approach is required to ensure patients are investigated and treated for osteoporosis as necessary following a fragility fracture.
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