Aims:
Poor dentition can be a barrier to antiresorptive prescription given concerns regarding medication-related osteonecrosis of the jaw (MRONJ), particularly following invasive dental treatment. We examined the impact of a new inpatient dental review service on the prescription of antiresorptive therapy following minimal trauma hip fracture.
Methods:
This single-centre, retrospective, pre-post study compared two groups of patients ≥65 years presenting with minimal trauma hip fracture. Patient characteristics and outcome measures were collected from electronic medical records and compared between two time periods, before and after integration of inpatient dental review into the bone health assessment of these patients.
Results:
110 participants in the pre-group (mean age 82.4 ± 8.4 years, 63% female) and 132 participants in the post-group (mean age 86.6 ± 7.8 years, 74% female) were included. In the pre-group, 19/110 (17%) left hospital with newly prescribed antiresorptive therapy, compared to 42/132 (32%) in the post-group. A similar proportion of participants in each group were recommended dental clearance prior to antiresorptive therapy following bedside physician assessment (31/110 [28%] in the pre-group versus 39/132 [30%] in the post-group). In the post-group, 9/132 (7%) were newly prescribed antiresorptive therapy following dental clearance, whilst 17/132 (13%) were recommended dental treatment prior to commencing antiresorptive therapy. Inpatient dental review allowed for appropriate osteoporosis management in 20% of participants.
Conclusions:
Integration of a dental service in the multidisciplinary assessment of hip fracture patients facilitated appropriate prescription of antiresorptive therapy. Further studies are warranted to determine if this translates to a reduced rate of MRONJ.