Following hip fracture, hospital organizational factors associated with prescription of anti-osteoporosis medication on discharge, to address imminent refracture risk: a record-linkage study
Authors' conclusion
These novel, national findings highlight the importance of orthogeriatrician, physiotherapist, and occupational therapist involvement in secondary fracture prevention post hip fracture; notably, fracture risk reductions were seen within 12 mo of hip fracture.
Study context
- Population
- Patients aged ≥60 yr with hip fracture in England and Wales (2016–2019), 172 hospitals; mean (SD) age 82.7 (8.6) yr, 71% female, 18% admitted from care homes
- Participants
- 178,757 patients172 hospitals
- Exposure
- Hospital-level organizational factors
- Outcome
- (1) AOM prescription and (2) refracture (by ICD10 coding)
- Follow-up
- 1 yr
Methodological detailsrecord-linkage, multilevel models, national, Patient-level admission datasets, National Hip Fracture Database and mortality data linked to 71 metrics from 18 hospital-level organizational reports
- Record-linkage
- Multilevel models
- National
- Patient-level admission datasets, National Hip Fracture Database and mortality data linked to 71 metrics from 18 hospital-level organizational reports
Main finding
As reported in the abstract
1-yr follow-up
- Prescribed anti-osteoporosis medication (AOM) during admission
- 101 735 (57%)
- Refractured during 1-yr follow-up
- 12 240 (7%)
- Organizational factors associated with AOM prescription
- 12
- Orthogeriatrician-led care vs traditional care models, AOM prescription: OR
- 4.65 (2.25-9.59) (95% CI)
- Routine bone health assessment to all patients: AOM more likely to be prescribed
- 9% (6%-13%) (95% CI)
- Organizational factors associated with refracture risk
- 8
- Orthogeriatrician assessment to all patients within 72 h: lower refracture risk
- 18% (2%-31%) (95% CI)
- Weekend physiotherapy provision: lower refracture risk
- 8% (3%-14%) (95% CI)
- Occupational therapists attended clinical governance meetings: lower refracture risk
- 7% (2%-12%) (95% CI)
- Delays initiating post-discharge community rehabilitation: greater refracture risk
- 15% (3%-29%) (95% CI)
Observational data: associations, not effects.
Further findings
Time to refracture
- Median time to refracture
- 126 d (IQR 59-234)
Death during follow-up · 1-yr follow-up
- Died
- 50 354 (28%)
Original publication
Following hip fracture, hospital organizational factors associated with prescription of anti-osteoporosis medication on discharge, to address imminent refracture risk: a record-linkage study. J Bone Miner Res. Published 11 July 2024. doi:10.
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