11 research outputs found
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