Impact on morbidity and mortality and functional status after femur fracture in the elderly: underdiagnosis and undertreatment of osteoporosis

Abstract

Objective: To evaluate modifiable risk factors, mortality, functional impact, and treatment of osteoporosis before and after fragility hip fracture. Methods: Prospective observational study of elderly patients (>60 years) surviving hospitalization for proximal hip fracture at INTO between November 2018 and March 2019. Data were obtained through medical record review and telephone follow-up 18 months post-fracture, including the use of calcium and/or vitamin D, osteoporosis medication, and previous bone mineral density (BMD) testing. Functional status was classified as independent, partially or totally dependent. Descriptive analysis was performed with percentage frequency for categorical variables and mean for continuous variables. Results: Forty-one elderly patients were included, with a mean age of 75.6 years, 85.4% were female, 41.7% had a history of tobacco use, and 20% reported alcohol use. Only 36.6% had undergone BMD testing prior to the fracture, 4.9% reported a previous fracture, and 5.7% refracture. Six patients died within 18 months, and 39% of survivors experienced a functional decline. After the fracture, there was an increase in the use of calcium (51.4%), but not vitamin D (11.4%), and only 14.3% were using alendronate. Conclusions: Although access to BMD testing is limited in the public healthcare system, the Fracture Risk Assessment Tool is a free tool that can stratify the risk of low-impact fracture. However, this type of fracture already establishes a clinical diagnosis of osteoporosis, impacts morbidity, mortality, and functional status in the elderly. Although primary and secondary fracture prevention measures are consensus-based, there seems to be insufficient awareness of this issue.

Objetivo: Avaliar fatores de risco modificáveis, mortalidade, impacto funcional e tratamento da osteoporose, antes e após fratura de fêmur por fragilidade. Métodos: Estudo observacional prospectivo com idosos (> 60 anos), sobreviventes à hospitalização por fratura de fêmur proximal, no INTO, com admissão hospitalar entre novembro de 2018 e março de 2019. Dados obtidos por revisão de prontuários e ligação telefônica 18 meses pós-fratura: uso de cálcio e/ou vitamina D, uso de medicamento para osteoporose, realização prévia de densitometria mineral óssea (DMO). Status funcional classificado em independente, parcial ou totalmente dependente. Realizada análise descritiva com frequência percentual de variável categórica e média de variável contínua. Resultados: Incluídos 41 idosos, idade média 75,6 anos, sendo 85,4% mulheres, 41,7% com uso de tabaco e 20% de álcool. Realizaram DMO pré-fratura 36,6% dos pacientes, 4,9% informaram fratura prévia e 5,7% tinham refratura. Faleceram 6 idosos em 18 meses e 39% dos sobreviventes apresentaram declínio funcional. Após a fratura, constatamos aumento no uso de cálcio (51,4%), mas não de vitamina D (11,4%), com apenas 14,3% usando alendronato. Conclusões: Mesmo com acesso limitado no SUS à DMO, a Fracture Risk Assessment Tool é uma ferramenta gratuita que pode estratificar o risco de fratura de baixo impacto. Contudo, esse tipo de fratura já estabelece diagnóstico clínico de osteoporose, com impacto na morbimortalidade e queda no status funcional desses idosos. Apesar de as prevenções primária e secundária da fratura serem consensuais, parece não haver sensibilização suficiente ao tema ainda.