A multicenter survey on profile of care for hip fracture: predictors of mortality and disability.

Summary Because delay in time to surgery beyond 24\u201348 h has been observed in many studies to be associated with adverse outcomes, a survey in nine centers in Italy was undertaken to examine the impact of time to surgery on mortality and disability at 6 months after hospitalization. Introduction Delays in surgery for hip fracture have been reported to be associated with negative outcomes. However, most studies are based on retrospective analysis of hospital discharge data, which cannot determine functional status or general health status of patients prior to the fracture. Methods Using a prospective cohort design, data were collected on 3,707 patients aged >50 years during hospitalization for hip fracture and in a 6-month postdischarge follow-up. Baseline information included age, gender, living arrangement, prefracture walking ability, walking aid, ASA grade, type and reason of fracture, time to surgery, type of surgery, date and destination at discharge, and osteoporosis treatment. Follow-up data included living arrangement, walking ability, and mortality. Results Six-month mortality was positively associated with increasing age, comorbidity, prefracture functional disability, and having surgery more than 48 h after admission. Higher levels of functional status at 6 months were independently associated with surgery occurring within 24 h of the fracture and with osteoporosis therapy at discharge. Walking disability was associated with older age, comorbidity, disability before fracture, and time to surgery after 24 h. Conclusions Delay in surgery is a major cause of mortality and disability at 6 months, and interventions to modify this pattern of care are urgently needed

Osteoporosis Imaging in the Geriatric Patient

Given the expected rapid growth of the geriatric world population (=individuals aged >65 years) to 1.3 billion by 2050, age-related diseases such as osteoporosis and its sequelae, osteoporotic fractures, are on the rise. Areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) is the current gold standard to diagnose osteoporosis, to assess osteoporotic fracture risk, and to monitor treatment-induced BMD changes. However, most fragility fractures occur in patients with normal or osteopenic aBMD, indicating that factors beyond BMD impact bone strength. Recent developments in DXA technology such as TBS, VFA, and hip geometry analysis are now available to assess some of these non-BMD parameters from the DXA image. This review will discuss the use of DXA and DXA-assisted technologies and their respective advantages and disadvantages. Special attention is given to if and how each method is indicated in the geriatric population, and the latest ISCD 2015 guidelines have been incorporated