Study: Osteoporosis is Not Just a Woman's Disease
Each year, nearly two million Americans suffer osteoporosis-related fractures, and as the population ages that number is expected to increase dramatically, placing a major burden on the health care system.
While osteoporosis prevention and treatment efforts have historically been focused on post-menopausal women, a new study from Beth Israel Deaconess Medical Center suggests that critical opportunities are being lost by not focusing more attention on bone loss and fracture risk in older men.
“Given that the prevalence of fragility fractures among men is expected to increase threefold by the year 2050, adequately evaluating and treating men for osteoporosis is of paramount importance,” says lead author Tamara Rozental, MD, an investigator in BIDMC’s Department of Orthopaedics.
The study results appeared online November 5th in The Journal of Bone and Joint Surgery.
Rozental, who specializes in hand, wrist and elbow injuries, examined five years of data (2007 - 2012) from patients who suffered a distal radial fracture — a break near the wrist end of the radius, the larger of the two long bones in the forearm.
“We know that a distal radial fracture can often be an early indication of bone loss. We typically see this type of fracture 10 to 15 years before we might see a hip fracture,” says Rozental, an Associate Professor of Orthopedic Surgery at Harvard Medical School (HMS). “When we treat fractures of the wrist, it gives us the opportunity to do a bone mass density (BMD) evaluation and, if necessary, get patients into treatment with the goal of preventing more serious injury, like a hip fracture down the line.”
Even though existing clinical practice guidelines recommend BMD evaluation after hip fracture for both men and women, studies continue to show that screening rates are unacceptably low, particularly among men, highlighting a critical gap in care. Rozental (right) examined the data to see if the same trend would play out when examining clinical follow up to wrist fractures.
Rozental found that following a wrist fracture, 53 percent of women received Dual X-ray Absorptiometry, the preferred technique for measuring bone mineral density, compared with only 18 percent of men. Additionally, 21 percent of men versus 55 percent of women initiated treatment with calcium and vitamin D supplements within six months of injury, and three percent of men versus 22 percent of women started taking bisphosphonates, a common drug treatment for increasing bone mass.
“We think it’s important to reinforce the fact that osteoporosis is not just a woman’s disease,” says Rozental. “Treating men for bone fractures, but not the underlying cause, places them at a greater risk for future bone breaks and related complications. The results of this study lead us to suggest that men over the age of 50 with fractures of the distal radius should undergo further clinical assessment and bone density testing to better identify those at high risk for future fracture as well as those who would benefit from further treatment.”
Studies have shown that men have twice the mortality rate of women both during initial hospitalization and in the year following a hip fracture. Survival rates following a wrist fracture, the number-one upper extremity fracture in older adults, also are lower among men.
In addition to Rozental, study authors include HMS investigators Carl Harper, MD, and Shannon Fitzpatrick, MD and David Zurakowski, PhD, from Children’s Hospital, Boston.
Identifying Delirium is Key for Hospitalized Elders
It’s an all-too-familiar situation: An elderly patient falls and fractures his hip. He is admitted to the hospital and undergoes surgery. During the recovery period, he becomes extremely confused and refuses to work with the physical therapist. Frustrated at not being able to get out of bed, the patient grows further agitated and distraught.
And from there can begin a rapid downward spiral. Given a sedative to calm down, the patient instead becomes overly lethargic — posing the risk of still more complications, including choking, pneumonia and bed sores. Ultimately, his fragile medical condition can lead to long-term disability or even death.
At the root of this “cascade of adverse events” is delirium, an acute state of confusion that often affects older individuals following surgery or serious illness. Sometimes accompanied by disorientation, paranoia and hallucinations, delirium develops in 30 to 50 percent of all hospitalized seniors.
“Delirium can affect any age group, but is most often seen in older patients,” explains Beth Israel Deaconess Medical Center gerontologist Edward Marcantonio, MD, SM, who as the Section Chief for Research in BIDMC’s Division of General Medicine and Primary Care, has spent more than 20 years conducting research on this condition.
“It is a syndrome [a cluster of symptoms] that develops from a combination of chronic predisposing factors and acute precipitating factors; the more risk factors you have prior to the acute event, the less precipitants you need to become delirious,” he adds.
In other words, while it might take a major trauma to bring about delirium in a young person, in a more fragile older person, the threshold is likely to be much lower — even taking a sleeping pill could trigger the problem.
Although delirium is estimated to complicate hospital stays for more than 2.5 million elderly individuals in the United States each year, this common condition often goes undetected, in part because the standard clinical evaluation for delirium takes 60 to 90 minutes and involves questioning the patient, hospital staff and caregivers, as well as reviewing the patient’s medical chart.
Now Marcantonio, together with a group of researchers, has developed a three-minute screening test for delirium that could help to make it easier for clinicians to recognize this serious condition.
Read more about the screening test »
“Prompt recognition of delirium is the first step to timely evaluation treatment, preventing complications and keeping older patients safe while they are in the hospital,” says Marcantonio.
Because delirium can often be mistaken for dementia in elderly patients, the screening helps doctors distinguish between inattention — a classic characteristic of delirium — and memory loss, which is most typical of dementia.
Once delirium has been identified, there are a number of basic steps that hospital caregivers and family members can take to help the patient. First and foremost is a careful assessment to determine potential acute factors contributing to delirium, and correcting as many of these as possible. This includes carefully reviewing the patient’s medication list and stopping drugs that might be contributing to confusion, evaluating the patient for new unrecognized medical problems, and making certain that pain is effectively managed.
Also important is ensuring patient safety, making certain the patient is oriented to his or her environment, ensuring the patient uses vision and hearing aids, as necessary, and getting the patient out of bed.
“As growing numbers of older adults are being hospitalized, it’s critically important that doctors, nurses and other hospital care providers be able to recognize delirium,” says Marcantonio. “Family members can also play a key role. Companionship is important to the delirious patient, and conversation and sharing photos or other mementoes can help restore orientation and awareness. Patients with delirium often can’t express their needs, and family members also play an important role as advocates.”
BIDMC Named a Leader in LGBT Healthcare Equality
Beth Israel Deaconess Medical Center has been recognized as a “Leader in LGBT Healthcare Equality” by the Human Rights Campaign (HRC) Foundation, the educational arm of the country’s largest lesbian, gay, bisexual and transgender (LGBT) civil rights organization.
The findings were part of HRC Foundation’s Healthcare Equality Index 2014, a unique annual survey that encourages equal care for LGBT Americans, and recognizes healthcare institutions doing the best work.
BIDMC earned top marks in meeting non-discrimination and training criteria that demonstrate its commitment to equitable, inclusive care for LGBT patients, and their families, who can face significant challenges in securing the quality health care and respect they deserve.
“Our HEI recognition showcases that we continue to embody Human First, to be sensitive to the needs of our lesbian, gay, bisexual, and transgender patients, and to be a welcoming place for all our patients, irrespective of their sexual orientation or gender identity,” says Kevin Tabb, MD, BIDMC’s President and CEO.
BIDMC is one of a select group of healthcare organizations nationwide to be named Leaders in LGBT Healthcare Equality. Organizations awarded this title meet key criteria, including patient and employee non-discrimination policies that specifically mention sexual orientation and gender identity, a guarantee of equal visitation for same-sex partners and parents, and LGBT health education for key staff members.
“Leaders in LGBT Healthcare Equality change the lives of LGBT patients and their families for the better each and every day,” says Chad Griffin, HRC president. "LGBT people should be treated equally in all aspects of our lives, and HRC celebrates Beth Israel Deaconess Medical Center for their tireless work to create an inclusive and welcoming environment for all patients.”
The Healthcare Equality Index offers healthcare facilities unique and powerful resources designed to help provide equal care to a long-overlooked group of patients, as well as assistance in complying with new regulatory requirements and access to high-quality staff training.
For more information about the Healthcare Equality Index 2014, or to download a free copy of the report, visit hrc.org/hei.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.