Improving Patients' Outcomes After Osteoporotic Fractures

Rozalia Dimitriou; Giorgio Maria Calori; Peter V Giannoudis


Int J Clin Rheumatol. 2012;7(1):109-124. 

In This Article

Specific Considerations for Vulnerable Elderly Patients

This group of patients usually comprises patients over the age of 80 years, minimally ambulatory, with multiple medical comorbidities and cognitive impairment.[113] It is a greater challenge to improve final outcome for these patients after an osteoporotic fracture as there are patient-related barriers to initiate and maintain effective osteoporotic treatment and implement rehabilitation or secondary prevention strategies. Such barriers include among others coexisting dementia, severe medical comorbidities and polypharmacy, postoperative delirium, and inadequate social support in patients who live alone or have low socioeconomic status.[113] The advanced age itself in combination with the history of the fracture dramatically increases their risk for subsequent fracture and it is associated with a higher rate of comorbidities and polytherapy.

Often physicians who treat these patients may be discouraged to initiate osteoporotic treatment and secondary prevention due to risk of complications with some medications, lack of adherence with treatment, inadequate caregiver supervision or support, and shorter life expectancy.[113] They may even overlook calcium and vitamin D supplementation, in an effort to minimize the sum of daily medications. Nevertheless, efforts should be made to improve outcome in the vulnerable elderly patients by initiating treatment and prevention strategies through complex care paths or specialist referrals for these patients. These need to be initiated early and require coordination. Particularly in the rehabilitation hospital, where the patients are in a more stable condition, there are better opportunities to initiate these strategies and to promote adherence.[113]