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Undertreatment of Osteoporosis in Men With Hip Fracture
Gary M. Kiebzak, PhD;
Garth A. Beinart, MD;
Karen Perser, BA;
Catherine G. Ambrose, PhD;
Sherwin J. Siff, MD;
Michael H. Heggeness, MD, PhD
Arch Intern Med. 2002;162:2217-2222.
Background Women are not aggressively treated for osteoporosis after hip fracture;
the treatment status of men with hip fracture has not been extensively studied.
Objective To evaluate the outcome and treatment status of men with hip fracture.
Methods Data from medical records were obtained for 363 patients (110 men and
253 women) aged 50 years and older with atraumatic (low-energy) hip fracture
who were admitted to St Luke's Episcopal Hospital between January 1, 1996,
and December 31, 2000. Surveys were mailed to surviving patients. Main outcome
variables were osteoporosis treatments (antiresorptive or calcium and vitamin
D) at hospital discharge, current osteoporosis treatments at 1- to 5-year
follow-up, bone mineral density testing, mortality, current disability, and
living arrangements (home or institution).
Results The mean age for men was 80 years vs 81 years for women. Most fractures
(89% for men and 93% for women) resulted from falls from a standing height.
At hospital discharge, 4.5% of men (n = 5) had treatment of any kind for osteoporosis,
compared with 27% of women (n = 69) (P<.001).
The 12-month mortality was 32% in men, compared with 17% in women (P = .003). Surveys were usable from 168 (87%) of 194 survivors. At
1- to 5-year follow-up, 27% (12/44) of men were taking treatment of any kind
for osteoporosis, compared with 71% (88/124) of women (P<.001). Of those treated, 67% (8/12) of men and 32% (28/88) of
women were taking calcium and vitamin D only. At 1- to 5-year follow-up, 11%
of men had a bone mineral density measurement, compared with 27% of women.
After hospital discharge, the number of men and women who required wheelchairs,
walkers, and canes and who lived in institutions increased significantly.
Conclusions The burden of hip fracture is illustrated by the high incidence of postfracture
disability and the high mortality rate in both men and women. Nevertheless,
few men receive antiresorptive treatment.
From the Center for Orthopaedic Research and Education (Drs Kiebzak,
Siff, and Heggeness) and Department of Orthopaedic Surgery (Dr Siff), St Luke's
Episcopal Hospital; Department of Orthopaedic Surgery, Baylor College of Medicine
(Drs Kiebzak, Siff, and Heggeness), Houston, Tex; The University of Texas
Houston Medical School (Ms Perser); and Department of Orthopaedics, The University
of Texas Houston Health Science Center (Dr Ambrose). During the preparation
of this article, Dr Beinart was in medical school at Baylor College of Medicine.
He is now affiliated with the Department of Internal Medicine, University
of California, San Francisco.
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