Missed opportunity: Doctors should do more to help older patients with fractures avoid them in future

Fractures are not trivial for seniors, finds a new study led by a researcher from Laval University, since they are associated with a very high risk of mortality during the month following the injury.And even though hip fractures, for good reason, usually cause the most worry, they’re far the only fractures that represent an often unsuspected threat to the elderly, says the study’s lead author.“It’s unfortunate, but we often hear, ‘it’s normal, your mother is 88 years old, she broke her hip, you know, you have to die of something,’“ said Dr. Jacques P. Brown, clinical professor at the Faculty of Medicine of Laval University and a researcher the Centre de recherche du CHU de Québec-Laval University. “That’s often the attitude people have.”However, with appropriate care, these patients may be able to avoid a second fracture, and the subsequent burden on the health system. Physicians must “direct them to the right place,” rather than telling them, ‘well listen, it’s normal, you were 88 years old, we should avoid falling next time’ These are great opportunities that are being lost,” said the researcher.Dr. Brown and his colleagues used Ontario data to compare nearly 100,000 subjects aged 66 to 105 who had suffered a bone fracture to comparable subjects without injury.Hip fractures are the most devastating. Five years after such an injury, 45% of women were still alive, 24 percentage points lower than what was found in the comparison group. Vertebral fractures and proximal fractures (pelvis, femur, sternum, rib, humerus, shoulder) also considerably reduce the chances of survival over a five-year horizon.“These are fractures that require a lot of immobilization in bed, so they tend to get complicated,” said Dr. Brown—a situation that will often aggravate already existing health problems.Distal fractures (tibia, fibula, knee, radius, ulna and wrist) are the least threatening in this regard, with a difference of only four percentage points between the two groups, possibly because they “will cause less disability functional to patients, less bed rest, less immobilization, therefore fewer immediate complications,” he added.The worst survival rates were measured in men and in older patients.After the age of 50, noted Dr. Brown, approximately three-quarters of fractures that occur in daily life are associated with osteoporosis, for both men and women.However, taking medications to treat osteoporosis reduces the risk of new hip fractures by 40% over three years and the risk of vertebral fractures by 70% over one year, he stressed.“We realized that when you have one fracture, you are likely to quickly get a second one which also increases your short-term risk,” said Dr. Brown. “We observed that during two and a half years of follow-up, 20% of our cohort had presented with another fracture after leaving the hospital environment.”The year, and more specifically the month, following the fracture are particularly critical periods, since there is a rapid drop in the survival rate when there has been a hip fracture, fracture of the vertebrae or proximal fracture.The maximum risk of death occurs in the first four to six weeks after the fracture, Dr. Brown continued. Considering that patients may be hospitalized for a similar period of time before being transferred to a rehabilitation centre, there is an opportunity that is “missed,” he says. “We are losing a golden opportunity, at a time when they have not yet left the hospital, to tell them that they have an illness (osteoporosis) and to refer them to their family doctor for an evaluation and to initiate a treatment that exists, that is accessible free of charge and that could possibly prevent (the second fracture),” said Dr. Brown.The findings of this study were published by the Journal of Bone and Mineral Research Plus.This article was translated from its original French and was first published in our sister publication Profession Santé.

Missed opportunity: Doctors should do more to help older patients with fractures avoid them in future

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