Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-an
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REVIEW
Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-analysis L. Van Camp 1 & M. Dejaeger 2,3
&
J. Tournoy 2
&
E. Gielen 2,3
&
M. R. Laurent 3,4
Received: 20 April 2020 / Accepted: 16 June 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary This systematic review and meta-analysis found low-quality evidence that orthogeriatric care is positively associated with diagnosis of osteoporosis, prescription of calcium and vitamin D supplements and bisphosphonates in older hip fracture patients. Evidence on fall and fracture prevention was scarce and inconclusive. Orthogeriatrics may reduce the treatment gap following hip fractures. Introduction Hip fracture patients are at imminent risk of additional fractures and falls. Orthogeriatric care might reduce the osteoporosis treatment gap and improve outcomes in these patients. However, the optimal orthogeriatric care model (geriatric liaison service, co-management, or geriatrician-led care) remains unclear. Purpose To summarize the association of different orthogeriatric care models for older hip fracture patients, compared to usual orthopaedic care, with fall prevention measures, diagnosis and treatment of osteoporosis and future falls and fractures. Methods Two independent reviewers retrieved randomized controlled trials (RCTs) or controlled observational studies. Random effects meta-analysis was applied (PROSPERO ID: 165914). Results One RCT and twelve controlled observational studies were included, encompassing 20,078 participants (68% women, median ages between 75 and 85 years). Orthogeriatric care was associated with higher odds of diagnosing osteoporosis (odds ratio [OR] 11.36; 95% confidence interval [CI] 7.26–17.77), initiation of calcium and vitamin D supplements (OR 41.44; 95% CI 7.07–242.91) and discharge on anti-osteoporosis medication (OR 7.06; 95% CI 2.87–17.34). However, there was substantial heterogeneity in these findings. Evidence on fall prevention and subsequent fractures was scarce and inconclusive. Almost all studies were at high risk of bias. Evidence was insufficient to compare different care models directly against each other. Conclusions Low-quality evidence suggests that orthogeriatric care is associated with higher rates of diagnosing osteoporosis, initiation of calcium and vitamin D supplements and anti-osteoporosis medication. Whether orthogeriatric care prevents subsequent falls and fractures in older hip fracture patients remains unclear. Keywords Geriatric co-management . Hip fracture . Meta-analysis . Orthogeriatrics . Osteoporosis . Systematic review
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00198-020-05512-y) contains supplementary material, which is available to authorized users. * M. R. Laurent [email protected] 1
Faculty of Medicine, KU Leuven, Leuven, Belgium
2
Gerontology and Geriatrics section, Department of Public Health an
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