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Fragility fracture care gap at a tertiary teaching hospital in Malaysia

Fracture begets fracture, pharmacological treatment is needed to prevent secondary fractures. This study found that there was a fragility fracture care gap where both bone health investigations and treatment initiation rates were low. Strategies such as Fracture Liaison Service is needed to address...

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Main Authors: Cheah, Min Hui, Lai, Pauline Siew Mei, Khor, Hui Min, Ratnasingam, Jeyakantha, Chandrasekaran, C. Sankara Kumar, Singh, Simmrat, Zakaria, Mohd Idzwan, Ong, Terence
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Published: Springer London Ltd 2023
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RC Internal medicine
Online Access:http://eprints.um.edu.my/38253/
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spelling my.um.eprints.382532023-12-03T01:37:04Z http://eprints.um.edu.my/38253/ Fragility fracture care gap at a tertiary teaching hospital in Malaysia Cheah, Min Hui Lai, Pauline Siew Mei Khor, Hui Min Ratnasingam, Jeyakantha Chandrasekaran, C. Sankara Kumar Singh, Simmrat Zakaria, Mohd Idzwan Ong, Terence RC Internal medicine Fracture begets fracture, pharmacological treatment is needed to prevent secondary fractures. This study found that there was a fragility fracture care gap where both bone health investigations and treatment initiation rates were low. Strategies such as Fracture Liaison Service is needed to address the care gap.PurposeThis study aimed to investigate the clinical burden and secondary fracture prevention of fragility fractures at a tertiary teaching hospital in Malaysia.MethodsElectronic medical records of all patients admitted with fragility fractures between 1 January 2017-31 December 2018 were reviewed. Patients < 50 years old, with non-fragility fractures, restricted access to medical records, transferred to another hospital or who passed away during admission were excluded. Descriptive statistics were used to summarise patients' characteristics, frequency of fragility fractures, and secondary fracture prevention details. Binomial logistic regression was performed to analyse predictive factors for post-fracture bone health assessments and treatment initiation.Results1030 patients female (767/1030, 74.5%)] presented with 1071 fractures hip fractures (378/1071, 35.3%)]. 170/993 (17.1%) patients were initiated on anti-osteoporosis medications (AOMs) and 148/984 (15.0%) had bone mineral density (BMD) performed within 1-year post-fracture. Less than half (42.4%) of the patients remained on treatment at 1-year post-fracture. Older patients 65-74 years old: odds ratio (OR) = 2.18, 95%CI 1.05-4.52, p = 0.04; >= 75 years: OR = 3.06, 95%CI 1.54-6.07, p < 0.01], hip fractures (OR = 1.95, 95%CI 1.23-3.11, p < 0.01), Chinese ethnicity (OR = 1.90, 95%CI 1.07-3.35, p = 0.03),previously diagnosed with osteoporosis (OR = 2.65, 95%CI:1.32-5.31, p < 0.01) and a BMD test performed (OR = 12.48, 95%CI 8.04-19.37, p < 0.01) were found to have higher AOM initiation. Patients with past diagnosis of osteoporosis (OR = 4.45, 95%CI 2.25-8.81, p < 0.01) and initiated on AOM (OR = 11.34, 95%CI 7.57-16.97, p < 0.01) had a higher likelihood to undergo BMD testing.ConclusionThe AOM initiation and BMD testing rates were low. There is a need to address the fragility fracture care gap with strategies such as Fracture Liaison Service. Springer London Ltd 2023-05 Article PeerReviewed Cheah, Min Hui and Lai, Pauline Siew Mei and Khor, Hui Min and Ratnasingam, Jeyakantha and Chandrasekaran, C. Sankara Kumar and Singh, Simmrat and Zakaria, Mohd Idzwan and Ong, Terence (2023) Fragility fracture care gap at a tertiary teaching hospital in Malaysia. Archives of Osteoporosis, 18 (1). ISSN 1862-3522, DOI https://doi.org/10.1007/s11657-023-01256-4 <https://doi.org/10.1007/s11657-023-01256-4>. 10.1007/s11657-023-01256-4
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic RC Internal medicine
spellingShingle RC Internal medicine
Cheah, Min Hui
Lai, Pauline Siew Mei
Khor, Hui Min
Ratnasingam, Jeyakantha
Chandrasekaran, C. Sankara Kumar
Singh, Simmrat
Zakaria, Mohd Idzwan
Ong, Terence
Fragility fracture care gap at a tertiary teaching hospital in Malaysia
description Fracture begets fracture, pharmacological treatment is needed to prevent secondary fractures. This study found that there was a fragility fracture care gap where both bone health investigations and treatment initiation rates were low. Strategies such as Fracture Liaison Service is needed to address the care gap.PurposeThis study aimed to investigate the clinical burden and secondary fracture prevention of fragility fractures at a tertiary teaching hospital in Malaysia.MethodsElectronic medical records of all patients admitted with fragility fractures between 1 January 2017-31 December 2018 were reviewed. Patients < 50 years old, with non-fragility fractures, restricted access to medical records, transferred to another hospital or who passed away during admission were excluded. Descriptive statistics were used to summarise patients' characteristics, frequency of fragility fractures, and secondary fracture prevention details. Binomial logistic regression was performed to analyse predictive factors for post-fracture bone health assessments and treatment initiation.Results1030 patients female (767/1030, 74.5%)] presented with 1071 fractures hip fractures (378/1071, 35.3%)]. 170/993 (17.1%) patients were initiated on anti-osteoporosis medications (AOMs) and 148/984 (15.0%) had bone mineral density (BMD) performed within 1-year post-fracture. Less than half (42.4%) of the patients remained on treatment at 1-year post-fracture. Older patients 65-74 years old: odds ratio (OR) = 2.18, 95%CI 1.05-4.52, p = 0.04; >= 75 years: OR = 3.06, 95%CI 1.54-6.07, p < 0.01], hip fractures (OR = 1.95, 95%CI 1.23-3.11, p < 0.01), Chinese ethnicity (OR = 1.90, 95%CI 1.07-3.35, p = 0.03),previously diagnosed with osteoporosis (OR = 2.65, 95%CI:1.32-5.31, p < 0.01) and a BMD test performed (OR = 12.48, 95%CI 8.04-19.37, p < 0.01) were found to have higher AOM initiation. Patients with past diagnosis of osteoporosis (OR = 4.45, 95%CI 2.25-8.81, p < 0.01) and initiated on AOM (OR = 11.34, 95%CI 7.57-16.97, p < 0.01) had a higher likelihood to undergo BMD testing.ConclusionThe AOM initiation and BMD testing rates were low. There is a need to address the fragility fracture care gap with strategies such as Fracture Liaison Service.
format Article
author Cheah, Min Hui
Lai, Pauline Siew Mei
Khor, Hui Min
Ratnasingam, Jeyakantha
Chandrasekaran, C. Sankara Kumar
Singh, Simmrat
Zakaria, Mohd Idzwan
Ong, Terence
author_facet Cheah, Min Hui
Lai, Pauline Siew Mei
Khor, Hui Min
Ratnasingam, Jeyakantha
Chandrasekaran, C. Sankara Kumar
Singh, Simmrat
Zakaria, Mohd Idzwan
Ong, Terence
author_sort Cheah, Min Hui
title Fragility fracture care gap at a tertiary teaching hospital in Malaysia
title_short Fragility fracture care gap at a tertiary teaching hospital in Malaysia
title_full Fragility fracture care gap at a tertiary teaching hospital in Malaysia
title_fullStr Fragility fracture care gap at a tertiary teaching hospital in Malaysia
title_full_unstemmed Fragility fracture care gap at a tertiary teaching hospital in Malaysia
title_sort fragility fracture care gap at a tertiary teaching hospital in malaysia
publisher Springer London Ltd
publishDate 2023
url http://eprints.um.edu.my/38253/
_version_ 1784511838440914944
score 13.211869

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