Exploring the Impact of Race, Language, Socioeconomics, and Medical Management on Osteoporosis Workup and Treatment After Proximal Femur Fractures.

OBJECTIVES

To explore the impact of race, language, and socioeconomic status on vitamin D screening and osteoporosis treatment after operative management of proximal femur fractures.

METHODS

Design

Retrospective cohort.

Setting

Level I, II, and III Trauma Centers within an overarching institutional organization. Patient Selection Criteria: Patients greater than 65 years of age who underwent operative treatment for a proximal femur fracture between January 2020 and June 2023. Outcome Measures and Comparisons: Primary outcomes were rates of vitamin D screening and osteoporosis treatment. Secondary outcomes were rates of geriatric and endocrinology consultation during admission. Primary and secondary outcomes were compared by race, language, and socioeconomic status (Area of Deprivation Index [ADI]). ADI was recorded at the state level (0 to 10) using the ADI mapping tool with higher ADI indicating more socioeconomic disadvantage.

RESULTS

In total, 1149 patients were included (primary English-speaking: 89.2%, White: 90.3%, with intertrochanteric hip fractures: 76.6%). There were no differences in vitamin D screening or osteoporosis treatment observed between racial, language, or socioeconomic groups (P > 0.05). While non-English speakers were more likely to get an endocrine consult (OR 1.98, 95% CI 1.29-3.04, P = 0.002), Black patients or those with a higher ADI were less likely to receive endocrine consults (OR 0.30, 95% CI 0.11-0.81, P = 0.018 and OR 0.69, 95% CI 0.50-0.90, P = 0.008, respectively).

CONCLUSIONS

Black patients or those from higher area of deprivation neighborhoods were less likely to receive endocrine consults. Geriatric and endocrine consults increased the odds of obtaining vitamin D screening and osteoporosis treatment. Despite this finding, race, language, and socioeconomic status did not impact vitamin D screening or osteoporosis treatment after proximal femur fracture. The discrepancies in consultation based on non-clinical factors emphasize the importance of interdepartmental collaboration to optimize standardized osteoporosis treatment after proximal femur fracture and highlight disparities in osteoporosis care.

LEVEL OF EVIDENCE: Therapeutic Level III.