Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
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To assess the impact of the aging population on the occurrence of fragility fractures, we examined hospital discharges for hip fracture among U.S. women and men aged 45 years and older from 1993 through to 2003. The number of hospitalizations declined by 5%, and age-adjusted rates fell by over 20% for both women and men during this period. ⋯ Despite the increasing size of the older segment of the U.S. population, hospitalizations for hip fractures are not increasing. With declining lengths of stay there has been a reduced demand on hospital resources, although with average charges per hospitalization rising and more patients being discharged to other institutions for continuing care the economic consequences of hip fracture continue to increase.
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We studied nursing home residents with osteoporosis or recent fracture to determine the frequency and predictors of osteoporosis treatment. There was wide variation in performance, and both clinical and systems variables predicted use. This study shows that improvement in osteoporosis care is possible and important for many nursing homes. ⋯ There is substantial variation in the quality of osteoporosis treatment across nursing homes. Interventions that improve osteoporosis quality of care are needed.
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Review Meta Analysis
Association of estrogen receptor alpha gene polymorphisms with bone mineral density in Chinese women: a meta-analysis.
A large number studies have examined the association between estrogen receptor alpha (ESR-alpha) gene polymorphisms and bone mineral density (BMD) in the Chinese population. We conducted a meta-analysis to assess their pooled effects. ⋯ The PvuII polymorphism had a very weak association with femoral neck BMD whereas XbaI polymorphism was unlikely to be a predictor of femoral neck or spine BMD in Chinese women.
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Multicenter Study Controlled Clinical Trial
Persistence, reproducibility, and cost-effectiveness of an intervention to improve the quality of osteoporosis care after a fracture of the wrist: results of a controlled trial.
Older patients with fragility fractures are not commonly tested or treated for osteoporosis. Compared to usual care, a previously reported intervention led to 30% absolute increases in osteoporosis treatment within 6 months of wrist fracture. Our objective was to examine longer-term outcomes, reproducibility, and cost-effectiveness of this intervention. ⋯ A pragmatic intervention directed at patients and physicians led to substantial improvements in osteoporosis treatment, even when delivered 6-months post-fracture. From the healthcare payer's perspective, the intervention appears to have led to both cost-savings and gains in life expectancy.
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We report on a Canadian longitudinal qualitative case study of midlife women with fragility fractures, their treating orthopaedic surgeons and family physicians. ⋯ Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures.