Hip fracture prevention strategies in long-term care: A survey of Canadian physicians’ opinions
Canadian Family Physician
Vol. 56, No. 11, November 2010, pp.e392 - e397
Anna M. Sawka, MD PhD FRCPC -Endocrinologist and clinician scientist at the University Health Network in Toronto, Ont, an Assistant Professor at the University of Toronto, and holds a Health Services Research Chair from Cancer Care Ontario
Nofisat Ismaila - Research analyst at the University Health Network at the time of submission
Parminder Raina, PhD - Professor in the Department of Epidemiology and Biostatistics at McMaster University in Hamilton, Ont
Lehana Thabane, PhD - Associate Professor and Associate Chair in the Department of Epidemiology and Biostatistics at McMaster University
Sharon Straus, MSc MD FRCPC - Professor in the Department of Medicine at the University of Toronto and a Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute at St Michael’s Hospital in Toronto
Jonathan D. Adachi, MD FRCPC - Rheumatologist in the Department of Medicine at St Joseph’s Healthcare in Hamilton and a Professor in the Department of Medicine at McMaster University
Amiram Gafni, PhD - Professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University
Alexandra Papaioannou, MD FRCPC - Professor in the Department of Medicine at Hamilton Health Sciences
Correspondence: Dr Anna M. Sawka, Division of Endocrinology and Metabolism, Department of Medicine, Toronto General Hospital, 200 Elizabeth St, 12 EN-212, Toronto, ON M5G 2C4; telephone 416 340-3678; e-mail sawkaam at yahoo.com
OBJECTIVE?To garner Canadian physicians’ opinions on strategies to reduce hip fractures in long-term care (LTC) facilities, focusing on secondary prevention.
DESIGN?A cross-sectional survey using a mailed, self-administered, written questionnaire.
SETTING?Canada.
PARTICIPANTS?Family physician members of the Ontario Long-Term Care Association (n = 165) and all actively practising geriatricians registered in the Canadian Medical Directory (n = 81).
MAIN OUTCOME MEASURES?The strength of recommendations for fracture-reduction strategies in LTC and barriers to implementing these strategies.
RESULTS?Of the 246 physicians sent the questionnaire, 25 declined study materials and were excluded. Of the 221 remaining, 120 responded for a response rate of 54%. About two-thirds of respondents were family physicians (78 of 120) and the rest were mostly geriatricians. Most respondents strongly recommended the following secondary prevention strategies for use in LTC after hip fracture: calcium, vitamin D, oral aminobisphosphonates, physical therapy, and environmental modification (such as handrails). Most respondents either did not recommend or recommended limited use of etidronate, intravenous bisphosphonates, calcitonin, raloxifene, testosterone (for hypogonadal men), and teriparatide. Postmenopausal hormone therapy was discouraged or not recommended by most respondents. Support was mixed for the use of hip protectors, B vitamins, and folate. Barriers to implementation identified by most respondents included a lack of strong evidence of hip fracture reduction (for B vitamins and folate, cyclic etidronate, and testosterone), side effects (for postmenopausal hormone therapy), poor compliance (for hip protectors), and expense (for intravenous bisphosphonates and teriparatide). Some respondents cited side effects or poor compliance as barriers to using calcium and potent oral bisphosphonates.
CONCLUSION?Canadian physicians favour the use of calcium, vitamin D, potent oral bisphosphonates, physical therapy, and environmental modifications for LTC residents after hip fracture. Further study at the clinical and administrative levels is required to find ways to overcome the specific barriers to implementation and effectiveness of these interventions.
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Note: Recommendation for preventing ANOTHER hip fracture, not preventing the first one