Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Does Simultaneous Computed Tomography and Quantitative Computed Tomography Show Better Prescription Rate than Dual-energy X-ray Absorptiometry for Osteoporotic Hip Fracture?

  • Ko, Jae Han (Department of Orthopaedic Surgery, Yonsei Barun Orthopaedic Surgery Clinic) ;
  • Lim, Suhan (Department of Orthopaedic Surgery, Yonsei University College of Medicine) ;
  • Lee, Young Han (Department of Radiology, Yonsei University College of Medicine) ;
  • Yang, Ick Hwan (Department of Orthopaedic Surgery, Yonsei University College of Medicine) ;
  • Kam, Jin Hwa (Department of Orthopaedic Surgery, Yonsei University College of Medicine) ;
  • Park, Kwan Kyu (Department of Orthopaedic Surgery, Yonsei University College of Medicine)
  • Received : 2018.08.14
  • Accepted : 2018.11.01
  • Published : 2018.12.01
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to evaluate the efficacy of simultaneous computed tomography (CT) and quantitative CT (QCT) in patients with osteoporotic hip fracture (OHF) by analyzing the osteoporosis detection rate and physician prescription rate in comparison with those of conventional dual-energy X-ray absorptiometry (DXA). Materials and Methods: This study included consecutive patients older than 65 years who underwent internal fixation or hip arthroplasty for OHF between February and May 2015. The patients were assigned to either the QCT (47 patients) or DXA group (51 patients). The patients in the QCT group underwent QCT with hip CT, whereas those in the DXA group underwent DXA after surgery, before discharge, or in the outpatient clinic. In both groups, the patients received osteoporosis medication according to their QCT or DXA results. The osteoporosis evaluation rate and prescription rate were determined at discharge, postoperative (PO) day 2, PO day 6, and PO week 12 during an outpatient clinic visit. Results: The osteoporosis evaluation rate at PO week 12 was 70.6% (36 of 51 patients) in the DXA group and 100% in the QCT group (P<0.01). The prescription rates of osteoporosis medication at discharge were 70.2% and 29.4% (P<0.001) and the cumulative prescription rates at PO week 12 were 87.2% and 60.8% (P=0.003) in the QCT and DXA groups, respectively. Conclusion: Simultaneous CT and QCT significantly increased the evaluation and prescription rates in patients with OHF and may enable appropriate and consistent prescription of osteoporosis medication, which may eventually lead to patients' medication compliance.

Keywords

References

  1. Watts NB, Lewiecki EM, Miller PD, Baim S. National Osteoporosis Foundation 2008 Clinician's Guide to Prevention and Treatment of Osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist. J Clin Densitom. 2008;11:473-7. https://doi.org/10.1016/j.jocd.2008.04.003
  2. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178-208. https://doi.org/10.1093/oxfordjournals.epirev.a036281
  3. Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ 3rd. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137:1001-5. https://doi.org/10.1093/oxfordjournals.aje.a116756
  4. Lyles KW, Colon-Emeric CS, Magaziner JS, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357:1799-809. https://doi.org/10.1056/NEJMoa074941
  5. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15:721-39.
  6. Schurch MA, Rizzoli R, Mermillod B, Vasey H, Michel JP, Bonjour JP. A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res. 1996;11:1935-42.
  7. Trombetti A, Herrmann F, Hoffmeyer P, Schurch MA, Bonjour JP, Rizzoli R. Survival and potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int. 2002;13:731-7. https://doi.org/10.1007/s001980200100
  8. Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87:398-403. https://doi.org/10.2105/AJPH.87.3.398
  9. Andrade SE, Majumdar SR, Chan KA, et al. Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med. 2003;163:2052-7. https://doi.org/10.1001/archinte.163.17.2052
  10. Gong HS, Oh WS, Chung MS, Oh JH, Lee YH, Baek GH. Patients with wrist fractures are less likely to be evaluated and managed for osteoporosis. J Bone Joint Surg Am. 2009;91:2376-80. https://doi.org/10.2106/JBJS.H.01871
  11. Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD. Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum. 2006;35:293-305. https://doi.org/10.1016/j.semarthrit.2005.11.001
  12. Torgerson DJ, Dolan P. Prescribing by general practitioners after an osteoporotic fracture. Ann Rheum Dis. 1998;57:378-9. https://doi.org/10.1136/ard.57.6.378
  13. Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med. 2000;109:326-8. https://doi.org/10.1016/S0002-9343(00)00457-5
  14. Melton LJ 3rd, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective. How many women have osteoporosis? J Bone Miner Res. 1992;7:1005-10.
  15. 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-A:1063-70.
  16. Miller PD, Zapalowski C, Kulak CA, Bilezikian JP. Bone densitometry: the best way to detect osteoporosis and to monitor therapy. J Clin Endocrinol Metab. 1999;84:1867-71. https://doi.org/10.1210/jcem.84.6.5710
  17. Borders J, Kerr E, Sartoris DJ, et al. Quantitative dual-energy radiographic absorptiometry of the lumbar spine: in vivo comparison with dual-photon absorptiometry. Radiology. 1989;170:129-31. https://doi.org/10.1148/radiology.170.1.2909085
  18. Sartoris DJ, Resnick D. Current and innovative methods for noninvasive bone densitometry. Radiol Clin North Am. 1990;28:257-78.
  19. Wahner HW, Dunn WL, Brown ML, Morin RL, Riggs BL. Comparison of dual-energy x-ray absorptiometry and dual photon absorptiometry for bone mineral measurements of the lumbar spine. Mayo Clin Proc. 1988;63:1075-84. https://doi.org/10.1016/S0025-6196(12)65502-5
  20. Crilly RG, Kloseck M, Chesworth B, Mequanint S, Sadowski E, Gilliland J. Comparison of hip fracture and osteoporosis medication prescription rates across Canadian provinces. Osteoporos Int. 2014;25:205-10. https://doi.org/10.1007/s00198-013-2453-z
  21. Grover M, Anderson M, Gupta R, et al. Increased osteoporosis screening rates associated with the provision of a preventive health examination. J Am Board Fam Med. 2009;22:655-62. https://doi.org/10.3122/jabfm.2009.06.090040
  22. Kalender WA. Effective dose values in bone mineral measurements by photon absorptiometry and computed tomography. Osteoporos Int. 1992;2:82-7. https://doi.org/10.1007/BF01623841
  23. Huda W, Morin RL. Patient doses in bone mineral densitometry. Br J Radiol. 1996;69:422-5. https://doi.org/10.1259/0007-1285-69-821-422
  24. Kalender WA, Buchenau S, Deak P, et al. Technical approaches to the optimisation of CT. Phys Med. 2008;24:71-9. https://doi.org/10.1016/j.ejmp.2008.01.012
  25. Damilakis J, Adams JE, Guglielmi G, Link TM. Radiation exposure in X-ray-based imaging techniques used in osteoporosis. Eur Radiol. 2010;20:2707-14. https://doi.org/10.1007/s00330-010-1845-0
  26. Autier P, Haentjens P, Bentin J, et al. Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int. 2000;11:373-80. https://doi.org/10.1007/s001980070102
  27. Haentjens P, Autier P, Barette M, Boonen S. The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group. J Bone Joint Surg Am. 2001;83-A:493-500.
  28. Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367:2010-8. https://doi.org/10.1016/S0140-6736(06)68891-0
  29. Zethraeus N, Ben Sedrine W, Caulin F, et al. Models for assessing the cost-effectiveness of the treatment and prevention of osteoporosis. Osteoporos Int. 2002;13:841-57. https://doi.org/10.1007/s001980200117
  30. Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int. 2004;15:87-94. https://doi.org/10.1007/s00198-003-1515-z
  31. Li C, Mori S, Li J, et al. Long-term effect of incadronate disodium (YM-175) on fracture healing of femoral shaft in growing rats. J Bone Miner Res. 2001;16:429-36. https://doi.org/10.1359/jbmr.2001.16.3.429
  32. Cao Y, Mori S, Mashiba T, et al. Raloxifene, estrogen, and alendronate affect the processes of fracture repair differently in ovariectomized rats. J Bone Miner Res. 2002;17:2237-46. https://doi.org/10.1359/jbmr.2002.17.12.2237
  33. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90:1294-301. https://doi.org/10.1210/jc.2004-0952
  34. Rozental TD, Makhni EC, Day CS, Bouxsein ML. Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am. 2008;90:953-61. https://doi.org/10.2106/JBJS.G.01121

Cited by

  1. Comparison of quantitative computed tomography and dual-energy X-ray absorptiometry in elderly patients with vertebral and nonvertebral fractures: Preliminary results vol.4, pp.10, 2020, https://doi.org/10.28982/josam.790513