4.2 Article

Telecarers improve osteoporosis treatment and compliance rates in secondary osteoporosis prevention for elderly hip fracture patients

Journal

SINGAPORE MEDICAL JOURNAL
Volume 64, Issue 4, Pages 244-+

Publisher

WOLTERS KLUWER MEDKNOW PUBLICATIONS
DOI: 10.11622/smedj.2022068

Keywords

Hip fractures; osteoporosis; telemedicine

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Our study found a significant treatment gap in patients with osteoporosis, and we piloted the use of telecarers to monitor treatment and compliance. The results showed that telecarers were effective in monitoring osteoporosis treatment after hip fractures in the elderly population, but patient and family rejection as well as physician inertia were limiting factors.
Introduction: A significant treatment gap has been observed in patients with osteoporosis. Our previous audit found a 31.5% rate of anti-osteoporosis medication initiation after fragility fractures at one year. We piloted the use of telecarers to monitor osteoporosis treatment and compliance. Methods: From January 2017 to January 2018, all hip fracture patients at Changi General Hospital, Singapore, were automatically enrolled into the Health Management Unit valued care hip fracture programme. Telecarer calls were scheduled at discharge, 3, 6 and 12 months. We assessed the acceptability, completion and treatment rates of patients enrolled in this programme. Results: A total of 537 patients with a hip fracture were enrolled in the telecarer programme over one year. Their average age was 79.8 +/- 8.23 years, and 63.1% of them were female. A total of 341 patients completed 12 months of follow-up, of which 251 (73.6%) patients were on treatment at 12 months. The most common cause of lack of initiation of secondary osteoporosis treatment was patient or family rejection (34.4%), followed by physician failure to prescribe (24.4%) and renal impairment (24.4%). 16.7% of patients were deemed to have advanced dementia with a life-limiting illness and were, thus, deemed unsuitable for treatment. Conclusion: Telecarers may be a useful adjunct in the monitoring of osteoporosis treatment after hip fractures in an elderly population. The main limitations are patient or family rejection and physician inertia. Further studies should focus on a combination of interventions for both patients and physicians to increase awareness of secondary fracture prevention.

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