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Hip Fracture Vitamin D Update November 2007 Gregory Gahm, MD

Evercare Colorado. Informational Tidbits. 60-90% of NH residents fall annually20-50% of LTC pts who fall DIE the following year33% who have a hip fracture never walk againFrom start (ambulance) to finish (therapy ends), the average direct cost of treating a hip fracture in Colorado is about $30,

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Hip Fracture Vitamin D Update November 2007 Gregory Gahm, MD

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    1. Hip Fracture & Vitamin D Update November 2007 Gregory Gahm, MD

    2. Evercare Colorado Informational Tidbits 60-90% of NH residents fall annually 20-50% of LTC pts who fall DIE the following year 33% who have a hip fracture never walk again From start (ambulance) to finish (therapy ends), the average direct cost of treating a hip fracture in Colorado is about $30,000 (Taxpayers pay most of it…) Falls and hip fractures account for a significant percentage of malpractice suits and formal complaints against NHs

    3. Evercare Colorado Statistics Review RR = Relative Risk CI = Confidence Interval RR is reported with a Confidence Interval statistically calculated based on magnitude of measured difference, # of study subjects, time… RRs w/ CIs: < 1.0: Result less likely to happen w/ Intervention > 1.0: Result more likely to happen w/ Intervention When CI includes 1.0: Can’t tell If CI does not include 1.0, there is a 95% chance the same result would occur no matter how many times you repeat the study

    4. Evercare Colorado Falls and Fractures Interventions shown to decrease falls in community-dwelling elderly: Muscle strengthening / balance retraining [RR 0.80*; CI* 0.66-0.98] 15 Week Tai Chi group exercise [RR 0.51; CI 0.36-0.73] - only for active participants; benefits disappeared when exercise stopped Withdrawal of psychotropic medication [RR 0.34; CI 0.16-0.74] Multidisciplinary, multifactorial, health/environment RF screening /intervention trials {No Rx changes} [RR 0.79; CI 0.67-0.94] Same interventions in LTCFs are markedly less effective

    5. Evercare Colorado Hip Fractures and PPIs Pts >50 yo on Proton Pump Inhibitors (eg, Prilosec, Prevacid, Aciphex, Nexium, Omeprazole, Protonix) 13,556 hip fracture cases compared to 135,000 matched controls in the UK RR of hip fracture increased with dose, duration and age >1 year: RR = 1.44 [CI = 1.3-1.6] High Dose*: RR = 2.65 [CI = 1.8-3.9] *(>1.75x avg qd dose) JAMA, Dec 27, 06; Vol 296: 2947-53

    6. Evercare Colorado Clinical Trials of External Hip Protectors Early studies with < 50% compliance: Lauritzen (Lancet, 1993) 31 hip fxs in 418 controls [7.5%] vs 8 in 247 [3.2%] in treatment group. NONE on a pad protected hip. Kannus (NEJM, 2000) 21 hip fxs / 1000 pt-yrs [protected] vs 46 in the control group. 4 fxs on a pad protected hip. Ekman (Lancet, 1997) 21 hip fxs during study period NONE on a pad protected hip.

    7. Evercare Colorado Clinical Trials of EHPs Wiener & Birge (02): 19 fractures / 310 patient-years on unprotected hips - vs - 1 fracture / 320 patient-years on protected hips Pooled data from 6 major trials: 3553 subjects Hip fxs in 2.2% of those with EHPs vs 6.2% of control group Average compliance rates estimated to be about 40% NNT to prevent 1 fracture / year is ? 25-40 with 40% compliance or ? 10-12 with 85% compliance

    8. Evercare Colorado NH Chain National Hip Protector Study

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