Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Treatment of Osteoporosis after Hip Fracture: Survey of the Korean Hip Society

  • Jung-Wee Park (Department of Orthopedic Surgery, Seoul National University Bundang Hospital) ;
  • Je-Hyun Yoo (Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital) ;
  • Young-Kyun Lee (Department of Orthopedic Surgery, Seoul National University Bundang Hospital) ;
  • Jong-Seok Park (Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan) ;
  • Ye-Yeon Won (Department of Orthopedic Surgery, Ajou University College of Medicine)
  • Received : 2023.05.17
  • Accepted : 2023.07.12
  • Published : 2024.03.01
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Abstract

Purpose: To assess current practice in the treatment of osteoporosis in patients who underwent treatment for hip fracture in South Korea. Materials and Methods: A survey of 97 members of the Korean Hip Society, orthopedic hip surgeons who administer treatment for hip fractures in South Korea, was conducted. The survey was conducted for assessment of demographic data and perceptions regarding the management of osteoporosis in patients who have undergone treatment for hip fracture. Analysis of the data was performed using descriptive statistical methods. Results: The majority of participants were between the age of 41 and 50 years, and 74% were practicing in tertiary hospitals. Testing for serum vitamin D levels (82%) was the most commonly performed laboratory test. Calcium and vitamin D were prescribed for more than 80% of patients by 47% and 52% of participants, respectively. Denosumab was the most commonly used first-line treatment option for osteoporosis in hip fracture patients. Bisphosphonate was most often perceived as the cause of atypical femoral fractures, and the most appropriate time for reoperation was postoperative 12 months. Teriparatide was most preferred after cessation of bisphosphonate and only prescribing calcium and vitamin D was most common in high-risk patients for prevention of atypical femoral fracture. Conclusion: The results of this study that surveyed orthopedic hip surgeons showed that most participants followed the current strategy for management of osteoporosis. Because the end result of osteoporosis is a bone fracture, active involvement of orthopedic surgeons is important in treating this condition.

Keywords

Acknowledgement

This study was presented in the Fracture Symposium of the Korean Hip Society in November 2022.

References

  1. Ahn SH, Park SM, Park SY, et al. Osteoporosis and osteoporotic fracture fact sheet in Korea. J Bone Metab. 2020;27:281-90. https://doi.org/10.11005/jbm.2020.27.4.281 
  2. Oh YK, Moon NH, Shin WC. Management of osteoporosis medication after osteoporotic fracture. Hip Pelvis. 2022;34:191-202. https://doi.org/10.5371/hp.2022.34.4.191 
  3. Castel H, Bonneh DY, Sherf M, Liel Y. Awareness of osteoporosis and compliance with management guidelines in patients with newly diagnosed low-impact fractures. Osteoporos Int. 2001;12:559-64. https://doi.org/10.1007/s001980170077 
  4. Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA. Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am. 2000;82:1063-70. https://doi.org/10.2106/00004623-200008000-00001 
  5. Gardner MJ, Flik KR, Mooar P, Lane JM. Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am. 2002;84:1342-8. https://doi.org/10.2106/00004623-200208000-00008 
  6. Jin YZ, Lee JH, Xu B, Cho M. Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2019;20:399. https://doi.org/10.1186/s12891-019-2769-8 
  7. Kim SR, Ha YC, Park YG, Lee SR, Koo KH. Orthopedic surgeon's awareness can improve osteoporosis treatment following hip fracture: a prospective cohort study. J Korean Med Sci. 2011;26:1501-7. https://doi.org/10.3346/jkms.2011.26.11.1501 
  8. Barker KL, Toye F, Lowe CJ. A qualitative systematic review of patients' experience of osteoporosis using meta-ethnography. Arch Osteoporos. 2016;11:33. https://doi.org/10.1007/s11657-016-0286-z 
  9. Edwards BJ, Iris M, Ferkel E, Feinglass J. Postmenopausal women with minimal trauma fractures are unapprised of the existence of low bone mass or osteoporosis. Maturitas. 2006;53:260-6. https://doi.org/10.1016/j.maturitas.2005.05.008 
  10. Feldstein AC, Schneider J, Smith DH, et al. Harnessing stakeholder perspectives to improve the care of osteoporosis after a fracture. Osteoporos Int. 2008;19:1527-40. https://doi.org/10.1007/s00198-008-0605-3 
  11. Haaland DA, Cohen DR, Kennedy CC, Khalidi NA, Adachi JD, Papaioannou A. Closing the osteoporosis care gap: increased osteoporosis awareness among geriatrics and rehabilitation teams. BMC Geriatr. 2009;9:28. https://doi.org/10.1186/1471-2318-9-28 
  12. Oumer KS, Liu Y, Yu Q, Wu F, Yang S. Awareness of osteoporosis among 368 residents in China: a cross-sectional study. BMC Musculoskelet Disord. 2020;21:197. https://doi.org/10.1186/s12891-020-03217-1 
  13. Silverstein WK, Zipursky JS, Shadowitz S. Closing the osteoporosis care gap: a teachable moment. JAMA Intern Med. 2021;181:1635-6. https://doi.org/10.1001/jamainternmed.2021.5972 
  14. Bergmann P, Body JJ, Boonen S, et al. Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club. Int J Clin Pract. 2009;63:19-26. https://doi.org/10.1111/j.1742-1241.2008.01911.x 
  15. Vasikaran S, Cooper C, Eastell R, et al. International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clin Chem Lab Med. 2011;49:1271-4. https://doi.org/10.1515/CCLM.2011.602 
  16. Aspray TJ, Bowring C, Fraser W, et al. National Osteoporosis Society vitamin D guideline summary. Age Ageing. 2014;43:592-5. https://doi.org/10.1093/ageing/afu093 
  17. Weaver CM, Alexander DD, Boushey CJ, et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016;27:367-76. https://doi.org/10.1007/s00198-015-3386-5 Erratum in: Osteoporos Int. 2016;27:2643-6. https://doi.org/10.1007/s00198-016-3699-z 
  18. Bolland MJ, Grey A, Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol. 2018;6:847-58. https://doi.org/10.1016/S2213-8587(18)30265-1 
  19. Smith LM, Gallagher JC, Kaufmann M, Jones G. Effect of increasing doses of vitamin D on bone mineral density and serum N-terminal telopeptide in elderly women: a randomized controlled trial. J Intern Med. 2018;284:685-93. https://doi.org/10.1111/joim.12825 
  20. Grant AM, Avenell A, Campbell MK, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet. 2005;365:1621-8. https://doi.org/10.1016/S0140-6736(05)63013-9 
  21. Khaw KT, Stewart AW, Waayer D, et al. Effect of monthly high-dose vitamin D supplementation on falls and nonvertebral fractures: secondary and post-hoc outcomes from the randomised, double-blind, placebo-controlled ViDA trial. Lancet Diabetes Endocrinol. 2017;5:438-47. https://doi.org/10.1016/S2213-8587(17)30103-1 
  22. Bordelon P, Ghetu MV, Langan RC. Recognition and management of vitamin D deficiency. Am Fam Physician. 2009;80:841-6. Erratum in: Am Fam Physician. 2009;80:1357. 
  23. Ringe JD. Plain vitamin D or active vitamin D in the treatment of osteoporosis: where do we stand today? Arch Osteoporos. 2020;15:182. https://doi.org/10.1007/s11657-020-00842-0 
  24. Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009;361:756-65. https://doi.org/10.1056/NEJMoa0809493 Erratum in: N Engl J Med. 2009;361:1914. https://doi.org/10.1056/NEJMoa0809493 
  25. Brown JP, Prince RL, Deal C, et al. Comparison of the effect of denosumab and alendronate on BMD and biochemical markers of bone turnover in postmenopausal women with low bone mass: a randomized, blinded, phase 3 trial. J Bone Miner Res. 2009;24:153-61. https://doi.org/10.1359/jbmr.0809010 
  26. Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017;5:513-23. https://doi.org/10.1016/S2213-8587(17)30138-9 
  27. Watts NB, Grbic JT, Binkley N, et al. Invasive oral procedures and events in postmenopausal women with osteoporosis treated with denosumab for up to 10 years. J Clin Endocrinol Metab. 2019;104:2443-52. https://doi.org/10.1210/jc.2018-01965 
  28. Bone HG, Bolognese MA, Yuen CK, et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab. 2011;96:972-80. https://doi.org/10.1210/jc.2010-1502 
  29. Miller PD, Bolognese MA, Lewiecki EM, et al. Effect of denosumab on bone density and turnover in postmenopausal women with low bone mass after long-term continued, discontinued, and restarting of therapy: a randomized blinded phase 2 clinical trial. Bone. 2008;43:222-9. https://doi.org/10.1016/j.bone.2008.04.007 
  30. McClung MR. Cancel the denosumab holiday. Osteoporos Int. 2016;27:1677-82. https://doi.org/10.1007/s00198-016-3553-3 
  31. Kendler DL, Cosman F, Stad RK, Ferrari S. Denosumab in the treatment of osteoporosis: 10 years later: a narrative review. Adv Ther. 2022;39:58-74. https://doi.org/10.1007/s12325-021-01936-y 
  32. Chen LP, Chang TK, Huang TY, Kwok TG, Lu YC. The correlation between lateral bowing angle of the femur and the location of atypical femur fractures. Calcif Tissue Int. 2014;95:240-7. https://doi.org/10.1007/s00223-014-9887-y 
  33. Oh Y, Yamamoto K, Hashimoto J, et al. Biological activity is not suppressed in mid-shaft stress fracture of the bowed femoral shaft unlike in "typical" atypical subtrochanteric femoral fracture: a proposed theory of atypical femoral fracture subtypes. Bone. 2020;137:115453. https://doi.org/10.1016/j.bone.2020.115453 
  34. Park YC, Yoon SP, Yang KH. Localization of atypical femoral fracture on straight and bowed femurs. J Bone Metab. 2019;26:123-31. https://doi.org/10.11005/jbm.2019.26.2.123 
  35. Soh HH, Chua IT, Kwek EB. Atypical fractures of the femur: effect of anterolateral bowing of the femur on fracture location. Arch Orthop Trauma Surg. 2015;135:1485-90. https://doi.org/10.1007/s00402-015-2297-4 
  36. Takakubo Y, Miyaji T, Ohta D, et al. Differences in subtrochanteric and diaphyseal atypical femoral fractures in a super-aging prefectural area: YamaCAFe Study. J Bone Miner Metab. 2021;39:700-11. https://doi.org/10.1007/s00774-021-01215-4 
  37. Bernhard A, Milovanovic P, Zimmermann EA, et al. Micromorphological properties of osteons reveal changes in cortical bone stability during aging, osteoporosis, and bisphosphonate treatment in women. Osteoporos Int. 2013;24:2671-80. https://doi.org/10.1007/s00198-013-2374-x 
  38. Milovanovic P, Zimmermann EA, Riedel C, et al. Multilevel characterization of human femoral cortices and their underlying osteocyte network reveal trends in quality of young, aged, osteoporotic and antiresorptive-treated bone. Biomaterials. 2015;45:46-55. https://doi.org/10.1016/j.biomaterials.2014.12.024 
  39. Zimmermann EA, Schaible E, Gludovatz B, et al. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low-and high energy fracture conditions. Sci Rep. 2016;6:21072. https://doi.org/10.1038/srep21072 
  40. Lim SJ, Yeo I, Yoon PW, et al. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int. 2018;29:2427-35. https://doi.org/10.1007/s00198-018-4640-4 
  41. Hyodo K, Nishino T, Kamada H, Nozawa D, Mishima H, Yamazaki M. Location of fractures and the characteristics of patients with atypical femoral fractures: analyses of 38 Japanese cases. J Bone Miner Metab. 2017;35:209-14. https://doi.org/10.1007/s00774-016-0747-x 
  42. Schneider PS, Wall M, Brown JP, Cheung AM, Harvey EJ, Morin SN. Atypical femur fractures: a survey of current practices in orthopedic surgery. Osteoporos Int. 2017;28:3271-6. https://doi.org/10.1007/s00198-017-4155-4 
  43. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014;29:1-23. https://doi.org/10.1002/jbmr.1998 
  44. Shane E, Burr D, Ebeling PR, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010;25:2267-94. https://doi.org/10.1002/jbmr.253 Erratum in: J Bone Miner Res. 2011;26:1987. 
  45. Schilcher J, Michaelsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med. 2011;364:1728-37. https://doi.org/10.1056/NEJMoa1010650 Erratum in: N Engl J Med. 2011;365:1551. Erratum in: N Engl J Med. 2012;367:582. 
  46. Byun SE, Lee KJ, Shin WC, Moon NH, Kim CH. The effect of teriparatide on fracture healing after atypical femoral fracture: a systematic review and meta-analysis. Osteoporos Int. 2023;34:1323-34. https://doi.org/10.1007/s00198-023-06768-w 
  47. Langdahl BL, Libanati C, Crittenden DB, et al. Romosozumab (sclerostin monoclonal antibody) versus teriparatide in postmenopausal women with osteoporosis transitioning from oral bisphosphonate therapy: a randomised, open-label, phase 3 trial. Lancet. 2017;390:1585-94. https://doi.org/10.1016/S0140-6736(17)31613-6 
  48. Obermayer-Pietsch BM, Marin F, McCloskey EV, et al. Effects of two years of daily teriparatide treatment on BMD in postmenopausal women with severe osteoporosis with and without prior antiresorptive treatment. J Bone Miner Res. 2008;23:1591-600. https://doi.org/10.1359/jbmr.080506 
  49. Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016;31:16-35. https://doi.org/10.1002/jbmr.2708 Erratum in: J Bone Miner Res. 2016;31:1910. https://doi.org/10.1002/jbmr.2918 
  50. Dell R, Greene D. A proposal for an atypical femur fracture treatment and prevention clinical practice guideline. Osteoporos Int. 2018;29:1277-83. https://doi.org/10.1007/s00198-018-4506-9