A call to action: Accelerating hip fracture care with bone protection medicines and expedited surgery

In a new analysis of hip fracture care spanning across Australia and New Zealand, the report from the Australian and New Zealand Hip Fracture Registry (ANZHFR) has shed light on areas of improvement and opportunities in patient care. Published by Neuroscience Research Australia (NeuRA), this report draws insights from an expansive dataset encompassing 16,395 hip fractures across 97 hospitals in both countries.

Despite the challenges posed by post-COVID workforce shortages, the report underscores the critical importance of optimising patient care, particularly in bone protection medication administration. The findings come in the wake of the recent release of the revised Hip Fracture Clinical Care Standard, emphasising the need for expedited surgical interventions following hip fractures.

Annually, approximately 19,000 patients in Australia and 4,000 in New Zealand are admitted to hospitals with new hip fractures, and this figure is projected to rise as the population ages. Notably, hip fractures are most prevalent among individuals aged 65 and over, with an average age of 82 in both countries.

The report reveals a gradual increase in the percentage of patients being discharged from hospitals with treatment for osteoporosis, a significant factor in reducing the risk of future fractures. However, there is substantial room for improvement in this regard, as only 32% of patients left hospitals with vital bone protection medication such as bisphosphonates such as Sanofi’s Actonel (risedronate), Fosamax (alendronate), or others therapies such as Amgen’s Prolia (denosumab) in 2022.

According to Professor Jacqueline Close, Co-Chair of the ANZHFR and Principal Research Fellow at NeuRA, “Prescribing bone protection medication is of paramount importance as it significantly decreases the likelihood of future fractures. We undoubtedly have the capacity to do better, as just one-third of patients are currently receiving this crucial medication upon discharge.”

The report highlights a positive trend in the preoperative assessment of cognition and delirium in hip fracture patients, which has shown continuous improvement over five years across both Australia and New Zealand. Delirium, a common acute mental status change among older hip fracture patients, can be mitigated through proper screening and risk reduction strategies, ultimately enhancing patient outcomes.

Professor Close notes, “The use of nerve blocks for pain management remains robust, with 81% of patients receiving this intervention before entering the operating theatre.”

One concerning trend observed in the report is the increased time spent in the Emergency Department (ED) in both Australia and New Zealand. Additionally, the average time to surgery has lengthened, and the proportion of patients undergoing surgery within 48 hours has decreased in both countries.

Explaining the potential contributing factors, Professor Close states, “The rise in ED times is likely multifaceted, with factors such as increased trauma cases in the public sector, workforce shortages impacting both public and private sectors, and the growing medical complexity of our elderly population playing a role.”

She added, “Swift surgical intervention is crucial, as it is associated with fewer complications, improved recovery, and enhanced survival rates. Moreover, it is a cost-efficient approach, as each day of delay adds two days to a patient’s hospital stay.”

The report underscores several areas where Australia can enhance hip fracture care. Professor Close emphasised, “The evidence is clear: the sooner patients are encouraged to get out of bed, the better their functional recovery. Last year, fewer than half (45%) of patients took their first steps on the day following hip fracture surgery.”

In an effort to acknowledge excellence in hip fracture care, the Golden Hip Award was introduced in 2021. Hospitals in Australia and New Zealand that demonstrated outstanding performance in meeting the quality indicators of the Hip Fracture Care Clinical Care Standard were celebrated at the Hip Fest event held on the Sunshine Coast on September 11, 2023.

This year’s accolades include Concord Repatriation General Hospital, NSW, which received the Golden Hip Award for the best-performing hospital, and St Vincent’s Hospital, Sydney NSW, honoured with the Golden Hip Award for the most improved institution.

The ANZHFR Annual Report serves as a critical call to action, highlighting the potential for advancements in hip fracture care across Australia and New Zealand. As the population ages, prioritising the administration of bone protection medication and expediting surgical interventions emerge as crucial avenues to improve the lives of those affected by hip fractures.

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