OBSERVATIONS ON NURSING-HOME RESIDENTS WITH A HISTORY OF HIP FRACTURE

The authors evaluated nursing home residents with a prior history of h ip fracture for osteopenia and its risk factors, and attempted to lear n to what extent the residents' bone status had been considered by the ir primary care physicians, Thirty-one hip fracture residents in the M ilwaukee VA nursing home were studied to determine their status with r egard to bone mineral density of the proximal femur, and the following risk factors or predictors of osteopenia: history of smoking; history of fractures; calcium and vitamin D intake; underweight; immobility; hypogonadism; and administration of drugs that may accelerate bone dem ineralization, Data were also collected on the evaluation and manageme nt of the post hip fracture residents in three other nursing homes. In the Milwaukee nursing home, out of 31 hip fracture survivors, 74% had sustained a hip fracture before admission to the nursing home; 29% ha d a history of second fracture. In 84% of patients, there was no menti on of osteopenia in the active medical problem list and, therefore, th ere was no intervention plan in place to improve or prevent further bo ne loss, Thirty-two percent were underweight, 36% were currently smoki ng, 55% were immobile, 64% were consuming at least one medication that might increase bone loss, calcium intake was less than 1,000 mg daily in 52%, and 66% were hypogonadal (serum testosterone level less than 300 ng/dL). Chart reviews of the hip fracture survivors at three other nursing homes revealed similar findings, Approximately 5-15% of nursi ng home residents are hip fracture survivors. They usually have severe osteopenia and multiple risk factors for further bone loss and future fractures. These conditions are frequently not recognized or treated.