A virtual, closed-loop protocol for the treatment of hip fracture patients increased osteoporosis treatment rates, according to a study published in Endocrine Practice.
The prospective cohort study sought to assess the effectiveness of a virtual, closed-loop protocol that treated hip fracture patients without formal clinic visits. The study included an intervention cohort of 85 hip fracture patients (33.6%) with vitamin D levels ≥65 nmol/L who received recommendations for osteoporosis treatment and a non-intervention group of 168 patients (66.4%) with vitamin D <65 nmol/L.
Both cohorts received vitamin D loading in orthopedic and rehabilitation departments. In the intervention cohort, metabolic clinic physicians made virtual osteoporosis treatment recommendations to patients who achieved a vitamin D level ≥65 nmol/L. Recommendations were given without requiring clinic visits, and osteoporosis drug recommendations were relayed to primary care physicians.
Among 253 patients with a hip fracture (mean age, 81.3 years; 68.8% were women), the post-intervention osteoporosis medication issue rate (primary endpoint) was higher than in the non-intervention group (48.2% vs. 22.0%; P<0.001), although the researchers noted that treatment rates remained under 50% in both cohorts.
More patients in the intervention group received drugs three (18.8% vs. 2.9%; P<0.001) and six months (40% vs. 5.9%; P<0.001) after surgery. One-year mortality was lower in patients who received any osteoporosis medications (either through the intervention or from community physicians) than among untreated patients (5.1% vs. 26.3%; P<0.001).
“Additional research is required to increase treatment rates further, such as providing drug therapy shortly after surgery, perhaps during rehabilitation, or lowering the vitamin D threshold,” the researchers concluded.