Low handgrip strength is a predictor of osteoporotic fractures: Cross-sectional and prospective evidence from the Hong Kong Osteoporosis Study

Handgrip strength (HGS) is a potentially useful objective parameter to predict fracture since it is an indicator of general muscle strength and is associated with fragility and propensity to fall. Our objective was to examine the association of HGS with fracture, to evaluate the accuracy of HGS in predicting incident fracture, and to identify subjects at risk of fracture. We analyzed a cross-sectional cohort with 2,793 subjects (1,217 men and 1,576 women aged 50-101 years) and a subset of 1,702 subjects which were followed for a total of 4,855 person-years. The primary outcome measures were prevalent fractures and incident major fragility fractures. Each standard deviation (SD) reduction in HGS was associated with a 1.24-fold increased odds for major clinical fractures even after adjustment for other clinical factors. A similar result was obtained in the prospective cohort with each SD reduction in HGS being associated with a 1.57-fold increased hazard ratio of fracture even after adjustment for clinical factors. A combination of HGS and femoral neck bone mineral density (FN BMD) T-score values (combined T-score), together with other clinical factors, had a better predictive power of incident fractures than FN BMD or HGS T-score alone with clinical factors. In addition, combined T-score has better sensitivity and specificity in predicting incidence fractures than FN BMD alone. This study is the first study to compare the predictive ability of HGS and BMD. We showed that HGS is an independent risk factor for major clinical fractures. Compared with using FN BMD T-score of -2.5 alone, HGS alone has a comparable predictive power to BMD, and the combined T-score may be useful to identify extra subjects at risk of clinical fractures with improved specificity. © The Author(s) 2011.published_or_final_versionSpringer Open Choice, 21 Feb 201

A secondary Fracture Prevention Programme to reduce fractures, hospital admissions, and mortality rates

Conference Theme: Happy Staff - Healthy People (開心員工 - 共建民康)published_or_final_versionThe Hospital Authority Convention, Hong Kong, 10-11 May 2010

Evaluation of the Osteoporosis Secondary Fracture Prevention Program at Queen Mary Hospital: successful recruitment is associated with lower re-fracture rate and mortality rate at one year

Conference Theme: Happy Staff - Healthy People (開心員工 - 共建民康)published_or_final_versionThe Hospital Authority Convention, Hong Kong, 10-11 May 2010

A nurse-led clinic reduced osteoporosis clinic default rate and improved drug-adherence rate

The 12th Regional Osteoporosis Conference (ROC 2011), Hong Kong, 21-22 May 2011

Bone mineral density in patients with spine fracture treated with alendronate sodium and strontium ranelate

The 12th Regional Osteoporosis Conference (ROC 2011), Hong Kong, 21-22 May 2011

Factors associated with osteoporosis treatment adherence in Hong Kong

Poster presentations: Poster 6Introduction: Effective prevention of osteoporotic fracture requires long term adherence to osteoporosis medication. Longitudinal studies revealed that more than 60% of patients terminated their treatment at one year and the problem increases with time. The problem of non-adherence to osteoporosis medication in Hong Kong is unclear. Objective: To assess patient adherence to osteoporosis medication in Hong Kong and to identify the associating factors for nonadherence. Method: 244 patients attended the osteoporosis clinic in Queen Mary Hospital for the first time between January 2007 and December 2008 were invited to participate in a retrospective observational study for their adherence to treatment. Baseline clinical and demographic information, bone mineral density, lifestyle risk factors were assessed by medical charts review. Details in treatment adherence, acceptance, incident fractures, hospital admission and mobility level were collected by telephone interviews. Information were verified from the Hospital Authority Electronic Patient Record System. Medication compliance was measured by proportion of days covered (PDC). A patient is considered as a complier if he/she had missed < 20% of the proportion of days covered (PDC). Results: A total of 193 patients participated in this study with 79.1 % response rate. The mean rate of medication adherence was 75.3% (PDC) after a mean follow up of 2.3 years. The rate of medication adherence decreased progressively with follow up duration (PDC: 74.5% at first year, 75.6% at second year, 63.7% at third year). The risk factors for non-adherence to treatment were self-perceived having too many medications (OR: 19.77, 95% CI: 2.41-161.99, p<0.001); self-perceived adverse effect from medication (OR: 16.98, 95% CI: 2.04-141.35, p=0.001); self-perceived cannot afford the medication (OR: 14.29, 95% CI: 1.68-121.5, p=0.004); self-perceived not requiring the medication (OR: 9.53, 95% CI: 2.99-30.42, p <0.001); bedbound (OR: 9.19, 95% CI: 1.00-84.08, p=0.035); smoking (OR: 3.97, 95% CI: 1.23-12.76, p=0.025); unsatisfied with medication (OR: 3.17, 95% CI: 1.05-9.59, p=0.04) and medication adverse effect (OR: 1.15, 95% CI: 1.04-1.27, p<0.001). Conclusion: Although the rate of non-adherence in our study was lower than reported by overseas studies, the problem exacerbated with longer treatment duration. Several self-perceived factors were found associated with patient non-adherence. This study identified the common misconceptions and concerns about osteoporosis medications among patients that required long term treatment. To lower the non-adherence rate, doctors should improve their communications with patients to resolve their concerns with long term medical therapy.The 11th Regional Osteoporosis Conference (ROC), Hong Kong, 15-16 May 2010

Consolidating service receivers: Nurse-led Clinic in the management of osteoporosis to reinforce lifestyle modification, increase drug-adherence rate and Osteoporosis Clinic attendance rate at Queen Mary Hospital

Conference Theme: Consolidating Health Care - 固本培員, 健行不

Predictive factors for re-fracture in Chinese population with previous osteoporotic fractures

Poster presentations: Poster 8Introduction: Osteoporotic fracture is a leading cause for hospital admissions. It is known that the re-fracture rate is 3 to 5 folds higher in subjects with previous low-trauma fractures. The re-fracture rate and its predictive factors in Chinese population with previous osteoporotic fractures are unclear. The purpose of this prospective study was to determine the re-fracture rate and to identify its risk factors for Chinese with fractures. Methodology: A prospective, observational study on Southern Chinese aged 50 and above admitted to Queen Mary Hospital with low-trauma fractures of the hip, spine and distal radius. Subjects were followed yearly by telephone interview for the outcome of refracture. Information was verified from the Hospital Authority Electronic Patient Record System. Fracture of the skull, fingers, and toes were excluded. Cox proportional hazards model was used to identify the clinical risk factors for re-fractures. Results: 2,364 fracture patients (1,606 women and 758 men) admitted to Queen Mary Hospital between 2000 and 2009 were assessed. The mean age at their first fracture was 75.7 ± 10.9 years. At follow-up of 3.8 ± 2.8 years, 268 (11.3%) incident fractures were recorded. The most significant predictors for re-fracture were total hip BMD T-score 2cm shorter than at age 25, low back pain, difficult in bending forward, walk with aids, history of fall, and serum albumin < 39 g/L. In male subjects, patients with Parkinsonism and serum testosterone < 15 nmol/L were significant associated with re-fracture (Table One). Conclusions: Early identification of subjects with multiple clinical risk factors may help to reduce the re-fracture and hospital re-admission rates. Public health education on adverse lifestyle risk factors is important to reduce osteoporotic fractures.The 11th Regional Osteoporosis Conference (ROC), Hong Kong, 15-16 May 2010

A secondary fracture prevention programme to reduce fractures, hospital admissions, and mortality rates at one and five years

Poster presentations: Poster 1Introduction: Osteoporosis patients with a prior fracture have a much higher risk of re-fracture. Anti-osteoporosis medications reduce fractures only with prolonged treatment. In 2000, a Secondary Fracture Prevention Programme was piloted in Queen Mary Hospital to evaluate and treat patients with osteoporotic fractures. Objectives: (1) To triage and identify post-fracture patients with good survival and quality of life to minimize unnecessary osteoporosis drug treatment; (2) To reduce re-fractures, (3) To reduce mortality with osteoporosis drug treatment, and (4) To lower cost for hospitals to treat preventable re-fractures. Methodology: Patients with low-traumatic fractures underwent a structured evaluation and triage system for treatment and systematic follow-up programme. The triage was done by a registered nurse in-charged of the programme. Outcome measures included (1) refracture rate; (2) re-admission rate; and (3) mortality rate at 1-, and 5-years using survival analysis. Results: 2,364 fracture patients (1,606 female and 758 male) admitted to Queen Mary Hospital between April 2000 and April 2009 were screened. 1,078 (45.6%) had hip fractures, 565 (23.9%) spine fractures, 31 (13.2%) distal radius fractures and 410 (17.3%) fractures at other sites. 80.2% of patients fulfilled the inclusion criteria and were included into the program. About 80% of these patients were started on anti-osteoporotic medications. The re-fracture rate at 1 and 5 years of patients who received anti-osteoporosis medications were significantly lower than those did not receive medications (both p<0.05). Patients who satisfied the inclusion criteria but did not receive anti-osteoporosis medications had significantly higher re-admission and mortality rates at 1- and 5- years (all p<0.05). Patients who were excluded from the program have significantly lower re-fracture rate but higher mortality rates due to other causes at all time-points (all p<0.05). Anti-osteoporosis medications reduced risk of hip fractures by 88.8%, spine fractures by 88.3%, and other fractures by 82.8% at 12 months. The average cost of bisphosphonates, an effective anti-osteoporosis medication, is $1,400/patient-year. The Hospital Authority Statistical Report for 2007 recorded a total of 25,713 fractures. Based on these data, the secondary fracture prevention programme is estimated to provide a cost-saving of$100,260,300 per year. Conclusion: A structured triage and management programme for secondary fracture prevention was effective in identifying patients with better quality of life who are more likely to benefit from anti-osteoporosis medication, therefore reducing unnecessary drug prescription. Judicial use of anti-osteoporosis agents was effective in reducing re-fractures, and mortality and achieving cost-savings.The 11th Regional Osteoporosis Conference, Hong Kong, 15-16 May, 2010