Prevencija preloma kuka u gerijatrijskoj populaciji -- neiskorišćena prilika? (Slovenian).

Missed opportunities for prevention of hip fracture in older patients. (English)

HIP fractures; OSTEOPOROSIS; BONE fracture prevention; RISK factors of fractures; ORTHOPEDIC surgery; ALGORITHMS

Background/Aim. Osteoporotic fractures are a major cause of morbidity in the population. Therefore, fracture prevention strategies should be a major concern, and one of the priorities in the primary health care system. The aim of the study was to assess fracture and fall risk factors, and fracture risk level in patients with acute hip fracture, and to evaluate if there had been adequate osteoporosis treatment prior to fracture in this group of patients. Methods. Fracture and fall risk factors were assessed in 342 patients, ≥ 65 years old, hospitalized due to acute hip fracture at the Clinic for Orthopedic Surgery and Traumatology, Clinical Centre of Serbia in a 12-month period. Fall risk factors were assessed with the Fracture Risk Assessment (FRAX) algorithm, and patients were classified in respect to fracture risk level. Results. Hip fracture occurred in the majority of the patients in the high risk group (74.2%), where no additional bone mineral density testing was needed. Less than 10% of the patients had a diagnosis of osteoporosis before injury, while less than 2% were treated. Cognitive impairment (95.3%), visual impairment (58.2%), lower index of daily activities (51.8%), and depression (47.1%) were the most frequently observed fall risk factors. Conclusion. The results of our investigation reveal insufficient identification of clinical fracture risk factors in the primary care setting, inadequate treatment of osteoporosis and, consequently, ineffective prevention of hip fractures in the geriatric population. The introduction of FRAX into clinical practice enables more effective acknowledgment of patients with elevated fracture risk, even if bone density measurement is not available. The results of this study have a special significance for everyday clinical practice, because they impose a need for reviewing the existing approaches to osteoporosis prevention, and precise definiment of hip prevention strategies. [ABSTRACT FROM AUTHOR]

Uvod/cilj. Prevencija posledica osteoporoze postaje sve značajnija. Cilj rada bio je da se odredi prisustvo relevantnih faktora rizika od nastanka pada i preloma, stepen rizika od nastanka preloma, kao i adekvatnost lečenja osteoporoze pre povrede kod bolesnika hospitalizovanih zbog preloma kuka. Metode. Ispitivanjem su bila obuhvaćena 342 bolesnika, starosti ≥ 65 godina, koji su zbog akutnog preloma kuka lečeni na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Srbije u periodu od 12 meseci. Kod svih ispitivanih bolesnika analizirani su faktori rizika od nastanka preloma i pada putem Fracture Risk Assessment (FRAX) algoritma, a bolesnici su razvrstavani u odnosu na nivo rizika od nastanka preloma. Rezultati. Prelom kuka nastao je najčešće kod onih bolesnika koji su pripadali grupi sa visokim nivoom rizika (74,2%). Manje od 10% bolesnika je imalo dijagnozu osteoporoze pre povrede, dok je manje od 2% bolesnika lečeno od osteoporoye. Od faktora rizika od pada najzastupljeniji bili su: kognitivno oštećenje (95,3%), oštećenje vida (58,2%), sniženje aktivnosti dnevnog života (51,8%) i depresija (47,1%) Zaključak. Rezultati našeg istraživanja jasno ukazuju na nedovoljno prepoznavanje kliničkih faktora rizika od značaja za nastanak preloma i pada na nivou primarne zaštite, na neadekvatno lečenje osteoporoze, te, posledično, izrazito lošu prevenciju preloma kuka u gerijatrijskoj populaciji u našoj sredini. U lečenju starijih bolesnika savetuje se integrisani klinički pristup, koji podrazumeva merenje koštane gustine, kao i obaveznu rutinsku procenu kliničkih faktora rizika od nastanka preloma i pada. [ABSTRACT FROM AUTHOR]

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