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Ariie T, Yamamoto N, Tsutsumi Y, Nakao S, Saitsu A, Tsuge T, Tsuda H, Nakashima Y, Miura T, Bandai Y, Okoba R, Taito S. Association between a history of major osteoporotic fractures and subsequent hip fracture: a systematic review and meta-analysis. Arch Osteoporos 2024; 19:44. [PMID: 38816657 DOI: 10.1007/s11657-024-01393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/21/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE A history of fractures involving the distal radius, proximal humerus, spine, and hip may be associated with the incidence of subsequent hip fractures in older people. However, a comprehensive summary of this association using a rigorous methodology is lacking. Our objective was to systematically review the literature and examine the association between four major osteoporotic fractures and subsequent hip fractures in individuals aged ≥ 50 years. METHODS We searched MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov on February 15, 2023. The search included cohort or case-control studies investigating the association between these four types of osteoporotic fractures and subsequent hip fractures. We pooled the hazard ratios (HRs) with 95% confidence intervals (CI) using the random-effects model. We used the Quality In Prognosis Studies tool to assess the risk of bias in the included studies, and the grading of recommendations assessment, development, and evaluation approach to determine the certainty of evidence. RESULTS The selection process identified 48 studies for qualitative synthesis and 23 studies (2,239,217 participants) for meta-analysis. The overall methodological quality had a low risk of bias in 65% of the included studies. The association between a history of major osteoporotic fractures and subsequent hip fracture varied, with a high certainty of evidence for a history of proximal humerus and hip fractures (HR 2.02, 95% CI 1.75-2.33 and 2.86, 95% CI 1.92-4.25, respectively), moderate certainty for distal radius fractures (HR 1.66, 95% CI 1.53-1.81), and low certainty for spine fractures (HR 1.53, 95% CI 1.38-1.69). CONCLUSIONS In conclusion, a history of major osteoporotic fractures, particularly distal radius, proximal humerus, and hip fractures, is associated with subsequent hip fractures in older adults. Further research is needed to verify the association between a history of spine fracture and subsequent hip fractures. PROTOCOL REGISTRATION Open Science Framework ( https://osf.io/7fjuc ).
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Affiliation(s)
- Takashi Ariie
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa-Shi, Fukuoka, 831-8501, Japan.
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Norio Yamamoto
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Orthopedic Surgery, Hashimoto Hospital, Kagawa, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yusuke Tsutsumi
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- Human Health Science, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuri Nakao
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Division of Rehabilitation Medicine, Shimane University Hospital, Shimane, Japan
| | - Akihiro Saitsu
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Orthopedic Surgery, Jichi Medical University, Tochigi, Japan
- Medical Education Center, Jichi Medical University, Tochigi, Japan
| | - Takahiro Tsuge
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Rehabilitation, Kurashiki Medical Center, Okayama, Japan
| | - Haruka Tsuda
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Akihabara Medical Clinic, Tokyo, Japan
| | - Yuki Nakashima
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Takanori Miura
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Orthopedic Surgery, Akita Rosai Hospital, Akita, Japan
| | - Yousuke Bandai
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Rehabilitation Medicine, Shimada Hospital, Shimada Social Medical Corporation, Fukuoka, Japan
| | - Ryota Okoba
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Shunsuke Taito
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
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Schene MR, Wyers CE, Driessen JHM, Vranken L, Meijer K, van den Bergh JP, Willems HC. The "Can Do, Do Do" Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service. J Pers Med 2024; 14:337. [PMID: 38672964 PMCID: PMC11050804 DOI: 10.3390/jpm14040337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/28/2024] Open
Abstract
The "can do, do do" framework combines measures of poor and normal physical capacity (PC, measured by a 6 min walking test, can do/can't do) and physical activity (PA, measured by accelerometer, do do/don't do) into four domains and is able to categorize patient subgroups with distinct clinical characteristics, including fall and fracture risk factors. This study aims to explore the association between domain categorization and prospective fall, fracture, and mortality outcomes. This 6-year prospective study included patients visiting a Fracture Liaison Service with a recent fracture. Outcomes were first fall (at 3 years of follow-up, measured by fall diaries), first subsequent fracture, and mortality (at 6 years). Cumulative incidences of all three outcomes were calculated. The association between domain categorization and time to the three outcomes was assessed by uni- and multivariate Cox proportional hazard analysis with the "can do, do do" group as reference. The physical performance of 400 patients with a recent fracture was assessed (mean age: 64 years; 70.8% female), of whom 61.5%, 20.3%, and 4.9% sustained a first fall, sustained a subsequent fracture, or had died. Domain categorization using the "can do, do do" framework was not associated with time to first fall, subsequent fracture, or mortality in the multivariate Cox regression analysis for all groups. "Can't do, don't do" group: hazard ratio [HR] for first fall: 0.75 (95% confidence interval [CI]: 0.45-1.23), first fracture HR: 0.58 (95% CI: 0.24-1.41), and mortality HR: 1.19 (95% CI: 0.54-6.95). Categorizing patients into a two-dimensional framework seems inadequate to study complex, multifactorial outcomes. A personalized approach based on known fall and fracture risk factors might be preferable.
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Affiliation(s)
- Merle R. Schene
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Caroline E. Wyers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Johanna H. M. Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Department of Clinical Pharmacy, CARIM School for Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Joop P. van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Hanna C. Willems
- Internal Medicine and Geriatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Schene MR, Meijer K, Cheung D, Willems HC, Driessen JHM, Vranken L, van den Bergh JP, Wyers CE. Physical Functioning in Patients with a Recent Fracture: The "Can Do, Do Do" Framework Applied to Explore Physical Capacity, Physical Activity and Fall Risk Factors. Calcif Tissue Int 2023:10.1007/s00223-023-01090-3. [PMID: 37367955 PMCID: PMC10371931 DOI: 10.1007/s00223-023-01090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
Physical capacity (PC) and physical activity (PA) are associated physical performance measures, and combined, PC and PA are used to categorize physical performance in the "can do, do do" framework. We aimed to explore physical performance of patients attending the fracture liaison service (FLS). In this cross-sectional study, PC was measured by 6-min-walking-test (can't do/can do) and PA by accelerometer (don't do/do do). Following quadrants were defined based on predefined cut-off scores for poor performance: (1) "can't do, don't do"; (2) "can do, don't do"; (3) "can't do, do do"; (4) "can do, do do". Odds ratios (OR) were calculated and fall and fracture risk factors were assessed between quadrants. Physical performance of 400 fracture patients was assessed (mean age 64; female 70.8%). Patients performed as follows: 8.3% "can't do, don't do"; 3.0% "can do, don't do"; 19.3% "can't do, do do"; 69.5% "can do, do do". For the "can't do" group the OR for low PA was 9.76 (95% CI: 4.82-19.80). Both the "can't do, don't do" and "can't do, do do" group differed significantly compared to the "can do, do do" group on several fall and fracture risk factors and had lower physical performance. The "can do, do do" framework is able to identify fracture patients with an impaired physical performance. Of all FLS patients 20% "can't do, but "do do" while having a high prevalence of fall risk factors compared to persons that "can do, do do", which may indicate this group is prone to fall.
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Affiliation(s)
- M R Schene
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - K Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - D Cheung
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - H C Willems
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam, The Netherlands
| | - J H M Driessen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School of Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - L Vranken
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - J P van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - C E Wyers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Corrao G, Biffi A, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML. Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021. Front Endocrinol (Lausanne) 2023; 14:1137671. [PMID: 37143730 PMCID: PMC10151776 DOI: 10.3389/fendo.2023.1137671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field. Purpose This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline. Methods The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations. Results Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively. Conclusions The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
| | - Annalisa Biffi
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Luisella Cianferotti
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | - Raffaella Michieli
- Italian Society of General Medicine and Primary Care Società Italiana di Medicina Generale e delle cure primarie (SIMG), Florence, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Tiziana Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | | | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | - Maria Luisa Brandi
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
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Geusens P, Appelman-Dijkstra NM, Zillikens MC, Willems H, Lems WF, van den Bergh J. How to implement guidelines and models of care. Best Pract Res Clin Rheumatol 2022; 36:101759. [PMID: 35729036 DOI: 10.1016/j.berh.2022.101759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy.
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Affiliation(s)
- Piet Geusens
- Department of Rheumatology, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, Netherlands.
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine-Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Hanna Willems
- Department of Geriatrics, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands.
| | - Willem F Lems
- Department of Rheumatology, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands.
| | - Joop van den Bergh
- Department of Internal Medicine, VieCuri Medisch Cenrum, Tegelseweg 210, 5912 BL Venlo, Netherlands.
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Sahota A, Desai H, Hershkovica O, Sahota O. Poor Attendance for bone densitometry in patients at high risk of subsequent fragility fractures. J Clin Densitom 2022; 25:380-383. [PMID: 34973896 DOI: 10.1016/j.jocd.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/11/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
Fracture Liaison Services (FLS) are considered the most effective model for the prevention of subsequent fractures however, the uptake of these services has shown to be suboptimal. 6,528 patients were identified and referred on for bone densitometry assessment over a 6 yr period, however, 21% of these patients did not attend, with a trend towards a higher re-fracture rate in those that did not attend compared to those that did. The presence of a fragility fracture increases the risk of further fractures. Fracture Liaison Services (FLS) are considered the most effective model for the prevention of subsequent fractures, although the uptake amongst patients invited for bone densitometry assessment has shown to be suboptimal. The UK has one of the most comprehensive numbers of FLS, however the proportion and characteristics of patients identified through the FLS that do not respond to bone densitometry invitation, in the UK, remains unclear. We report the 6 yr. findings from the Nottingham FLS. The Nottingham Fracture Liaison Service (N-FLS) systematically identifies those adults aged 50 yr. and older with fragility fractures presenting to the fracture clinic and where appropriate, arranges referral for bone densitometry assessment. Routine clinical data is collected onto the N-FLS database. Patient characteristics, between January 2012 and December 2017, were examined of those referred for bone densitometry examination, comparing those that attended to those that did not attend (DNA). Deprivation scores for each patient were calculated using the English indices of deprivation 2015 (1-Most deprived; 5- Least deprived). Follow up data was available for those attending from 2016 onwards, which allowed an assessment of re-fracture. Over the 6 yr period, 6,528 patients as identified by the N-FLS were referred on for bone densitometry assessment. 1,386 patients (21%) did not attend (DNA) for bone densitometry assessment. The proportion was similar for each of the years. High prevalence of non-attendance was in females [1032 patients (74%)] and the most deprived individuals [398 patients (29%), which were significant when compared to those that did attend, p=0.042]. 826 patients were referred in 2016. Median follow-up time was 2.46 yr. (IQR 0.16-3.00 yr.). 52 (7%) patients, in this group, sustained a subsequent fracture (35 patients in the group that did not attend for bone density assessment and 17 in those that attend, p=0.092). Nottingham FLS have identified patients with fragility fractures that are at high-risk of further fractures. Despite a dedicated FLS, 21% of those invited for bone densitometry assessment, did not attend for their appointment, over the 6 yr. period, similar proportion each year. There was a significantly higher proportion of those identified as 'most deprived' not attending for a bone densitometry, compared to those who attended. Sub-analysis in those aged 75 yr. and over, showed a high non-attendance in this group. Further qualitative studies are necessary to explore this patient group in detail, who remain at high risk of re-fracture.
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Affiliation(s)
- Arunpreet Sahota
- Medical School, University of Leicester, Leicester, UK; Department of Ophthalmology, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Henal Desai
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK; Department of Ophthalmology, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Orly Hershkovica
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK; Department of Ophthalmology, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Opinder Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK; Department of Ophthalmology, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK; Division of Injury, Inflammation and Recovery Sciences, University of Nottingham, Nottingham, UK; Nottingham Biomedical Research Centre (BRC), National Institute for Health Research (NIHR) , Nottingham, UK.
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van den Berg P, van Leerdam M, Schweitzer DH. Covid-19 given opportunity to use ultrasound in the plaster room to continue secondary fracture prevention care: A retrospective Fracture Liaison Service study. Int J Orthop Trauma Nurs 2021; 43:100899. [PMID: 34530196 PMCID: PMC8405233 DOI: 10.1016/j.ijotn.2021.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/09/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Fracture Liaison Service (FLS) managed secondary fracture prevention services have been hampered during the COVID-19 pandemic. A challenging opportunity is to use pulse-echo ultrasound (P-EU) in the plaster room. The study had two objectives: can P-EU help our decision to justly avoid DXA/VFA scans in plaster treated women (50-70 years) after fracture and whether its use can encourage or nudge all plaster treated patients (>50 years) who need DXA/VFA scans. PATIENTS AND METHODS 1307 patients (cohort: pre-COVID-19) and 1056 patients (cohort: peri-COVID-19), each of them ≥ 50 years after recent fracture, were studied. Only in women aged 50-70 years, we used a P-EU decision threshold (DI) >= 0.896 g/cm2 to rule out further analysis by means of DXA/VFA. All other plaster patients received P-EU as part of patient information. Peri-Covid-19, all performed DXA/VFA scans were counted until three months post-study closure. By then each patient still waiting for a DXA/VFA had received a scan. RESULTS Peri-COVID-19, 69 out of 191 plaster-treated women aged 50-70 years were ruled out (36%), for plaster and not in-plaster treated women aged 50-70 years, it was 27%. Comparing all peri-to pre-COVID-19 plaster-treated women and men, a significant P-EU nudging effect was found (difference in proportions: 8.8%) P = .001. CONCLUSION The combination of patient information and P-EU in the plaster room is effective to reduce DXA/VFA scans and allow extra patients to undergo DXA/VFA. After all, more than a quarter of 50-70 years old women in plaster did not need to be scanned.
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Affiliation(s)
- Peter van den Berg
- Dept. of Orthopedics and Surgery, Fracture Liaison Service, Reinier de Graaf Gasthuis, Delft, the Netherlands.
| | | | - Dave H Schweitzer
- Dept. of Internal Medicine and Endocrinology, Reinier the Graaf Gasthuis, Delft, the Netherlands
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Olmo-Montes FJ, Hernández-Cruz B, Miranda MJ, Jimenez-Moreno MD, Vázquez-Gámez MÁ, Giner M, Colmenero MA, Pérez-Venegas JJ, Montoya-García MJ. The Fracture Liaison Service of the Virgen Macarena University Hospital Reduces the Gap in the Management of Osteoporosis, Particularly in Men. It Meets the International Osteoporosis Foundation Quality Standards. J Clin Med 2021; 10:jcm10184220. [PMID: 34575331 PMCID: PMC8465304 DOI: 10.3390/jcm10184220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/13/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe the Fracture Liaison Service (FLS), to know the characteristics of the patients attended with emphasis on sex differences, and to know the compliance of International Osteoporosis Foundation (IOF) quality standards. METHODS Observational, prospective research. All the consecutive patients that attended in usual clinical practice from May 2018 to October 2019, were over 50 years, and with a fragility fracture (FF), were included. RESULTS Our FLS is a type A multidisciplinary unit. We included 410 patients, 80% women. FF recorded in 328 women were: Hip (132, 40%), Clinical Vertebral (81, 25%) and No hip No vertebral (115, 35%). Those in 82 men were: Hip (53, 66%), Clinical Vertebral (20, 24%) and No hip No vertebral (9, 10%), p = 0.0001. Men had more secondary osteoporosis (OP). The most remarkable result was the low percentage of patients with OP receiving treatment and the differences between sex. Forty-nine (16%) women versus nine (7%) men had received it at some point in their lives, p = 0.04. The probability of a man not receiving prior treatment was 2.5 (95%CI 1.01-6.51); p = 0.04, and after the FF was 0.64 (0.38-1.09). Treatment adherence in the first year after the FLS was 96% in both sexes. The completion of IOF quality standards was bad for patient identification and reference time. It was poor for initial OP screening standard and good for the remaining ten indicators. CONCLUSIONS the FLS narrowed the gap in diagnosis, treatment, and follow-up of fragility fracture patients, especially men. The FLS meets the IOF quality standards.
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Affiliation(s)
- Francisco-Jesús Olmo-Montes
- Internal Medicine Department, Virgen Macarena University Hospital, Dr Fedriani Avenue No 3, 41009 Seville, Spain; (F.-J.O.-M.); (M.J.M.); (M.D.J.-M.); (M.-A.C.)
| | - Blanca Hernández-Cruz
- Rheumatology Department, Virgen Macarena University Hospital, Dr Fedriani Avenue No 3, 41009 Seville, Spain;
- Correspondence: ; Tel.: +34-954-78-22-06
| | - Mª José Miranda
- Internal Medicine Department, Virgen Macarena University Hospital, Dr Fedriani Avenue No 3, 41009 Seville, Spain; (F.-J.O.-M.); (M.J.M.); (M.D.J.-M.); (M.-A.C.)
| | - Mª Dolores Jimenez-Moreno
- Internal Medicine Department, Virgen Macarena University Hospital, Dr Fedriani Avenue No 3, 41009 Seville, Spain; (F.-J.O.-M.); (M.J.M.); (M.D.J.-M.); (M.-A.C.)
| | - Mª Ángeles Vázquez-Gámez
- PAIDI Research Group CTS/211, Medicine Department, School of Medicine, Seville University, Sanchez Pizjuan SN, 41009 Seville, Spain; (M.Á.V.-G.); (M.G.); (M.-J.M.-G.)
| | - Mercè Giner
- PAIDI Research Group CTS/211, Medicine Department, School of Medicine, Seville University, Sanchez Pizjuan SN, 41009 Seville, Spain; (M.Á.V.-G.); (M.G.); (M.-J.M.-G.)
| | - Miguel-Angel Colmenero
- Internal Medicine Department, Virgen Macarena University Hospital, Dr Fedriani Avenue No 3, 41009 Seville, Spain; (F.-J.O.-M.); (M.J.M.); (M.D.J.-M.); (M.-A.C.)
| | - José Javier Pérez-Venegas
- Rheumatology Department, Virgen Macarena University Hospital, Dr Fedriani Avenue No 3, 41009 Seville, Spain;
| | - María-José Montoya-García
- PAIDI Research Group CTS/211, Medicine Department, School of Medicine, Seville University, Sanchez Pizjuan SN, 41009 Seville, Spain; (M.Á.V.-G.); (M.G.); (M.-J.M.-G.)
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Javaid MK. Efficacy and efficiency of fracture liaison services to reduce the risk of recurrent osteoporotic fractures. Aging Clin Exp Res 2021; 33:2061-2067. [PMID: 34047929 PMCID: PMC8302543 DOI: 10.1007/s40520-021-01844-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/19/2021] [Indexed: 12/15/2022]
Abstract
Background Acting to prevent the next fracture after a sentinel fracture is support by the evidence base and brings benefits for patients, clinicians and healthcare systems. However, more patients after a fragility fracture remain untreated and vulnerable to future potentially life-changing fractures. Fracture liaison services (FLS) are models of care that can close this care gap. Methods A narrative review of the key evidence for the efficacy and effectiveness of FLS was performed Results There are few randomised control trials of FLSs and none with fracture as the primary outcome. Several observational studies have also demonstrated reductions in fracture, but most were limited by potential bias. Several studies have highlighted that not every FLS is automatically effective. Conclusion Further research should focus on implementing effective FLS using published standards and only then exploring impacts on patient outcomes such as refracture rates.
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Affiliation(s)
- M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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10
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Pasquale MK, Sheer RL, Yehoshua A, McFadden A, Chines A, Caloyeras J. Evaluation of an Osteoporosis Outreach Program for Men With a Fragility Fracture and Their Physicians. Med Care 2021; 59:148-154. [PMID: 33273290 PMCID: PMC7899217 DOI: 10.1097/mlr.0000000000001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many health plans have outreach programs aimed at appropriately screening, evaluating, and treating women experiencing fragility fractures; however, few programs exist for men. OBJECTIVE The objective of this study was to develop, implement, and evaluate an osteoporosis outreach program for men with a recent fragility fracture and their physicians. RESEARCH DESIGN AND SUBJECTS A total of 10,934 male patients enrolled in a Medicare Advantage with Prescription Drug Plan with a recent fragility fracture were randomized to a program or control group. Patients and their physicians received letters followed by phone calls on osteoporosis and the importance of screening and treatment. The evaluation compared bone mineral density (BMD) test utilization and osteoporosis medication treatment (OPT) among patients who received the outreach versus no outreach at 12 months. The effect of the program was estimated through univariate and multivariable logistic regressions. RESULTS The program had a significant impact on BMD evaluation and OPT initiation. At 12 months, 10.7% of participants and 4.9% of nonparticipants received a BMD evaluation. The odds ratio (OR) (95% confidence interval) was 2.31 (1.94, 2.76), and the number needed to outreach to receive a BMD test was 18. OPT was initiated in 4.0% of participants and 2.5% of nonparticipants. The OR (95% confidence interval) of receiving OPT was 1.60 (1.24, 2.07), and the number needed to outreach was 69. Adjusted ORs were similar in magnitude and significance. CONCLUSION The program was highly effective by more than doubling the rate of BMD evaluation; however, more intensive interventions may yield an even higher screening rate.
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11
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van den Berg P, van Haard PMM, Geusens PP, van den Bergh JP, Schweitzer DH. Characterization of fracture liaison service non-responders after invitation by home visits and questionnaires. Osteoporos Int 2020; 31:2007-2015. [PMID: 32405912 DOI: 10.1007/s00198-020-05442-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED This study aimed to gain insight in specific characteristics and beliefs of FLS non-responders. INTRODUCTION The proportion of non-responding fracture liaison service (FLS) invitees is high but characteristics of FLS non-responders are unknown. METHODS We contacted FLS non-responders by telephone to consent with home visit (HV) and to fill in a questionnaire or, if HV was refused, to receive a questionnaire by post (Q), to gain insight in beliefs on fracture cause and subsequent fracture risk. RESULTS Out of 716 FLS invitees, 510 attended, nine declined, and 197 did not respond. Of these non-responders, 181 patients were consecutively traced and phoned until 50 consented with HV. Forty-two declined HV but consented with Q. Excluded were eight Q-consenters in whom no choice was offered (either HV or Q) and 81 patients who declined any proposition (non-HV|Q). 62% HV and Q could recall the FLS invitation letter. The fracture cause was differently believed between HV and Q; the fall (96% versus 79%, p = .02), bad physical condition (36% versus 2%, p = .0001), dizziness or imbalance (24% versus Q 7%, p = .03), osteoporosis (16% versus 2%, p = .02), and increased fracture risk (26% versus 17%, NS). Age ≥ 70, woman, and major fracture were significantly associated with HV consent compared to Q (OR 2.7, 2.5, and 2.4, respectively) and HV compared to non-HV|Q (OR 16.8, 5.3, and 6.1). CONCLUSION FLS non-responders consider fracture risk as low. Note, 50 patients (about 25%) consented with a home visit after one telephone call, mainly older women with a major fracture. This non-responder subgroup with high subsequent fracture risk is therefore approachable for secondary fracture prevention.
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Affiliation(s)
- P van den Berg
- Department of Orthopedics and Trauma surgery, Fracture Liaison Service, Reinier de Graaf Hospital, Delft, The Netherlands.
| | - P M M van Haard
- Department of Medical Laboratories, Association of Clinical Chemistry, Reinier the Graaf Hospital, Delft, The Netherlands
| | - P P Geusens
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Hasselt University, Hasselt, Belgium
| | - J P van den Bergh
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Hasselt University, Hasselt, Belgium
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - D H Schweitzer
- Department of Internal Medicine and Endocrinology, Reinier the Graaf Hospital, Delft, The Netherlands
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12
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Javaid MK, Sami A, Lems W, Mitchell P, Thomas T, Singer A, Speerin R, Fujita M, Pierroz DD, Akesson K, Halbout P, Ferrari S, Cooper C. A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network. Osteoporos Int 2020; 31:1193-1204. [PMID: 32266437 PMCID: PMC7280347 DOI: 10.1007/s00198-020-05377-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/03/2020] [Indexed: 12/23/2022]
Abstract
The International Osteoporosis Foundation (IOF) Capture the Fracture® Campaign with the Fragility Fracture Network (FFN) and National Osteoporosis Foundation (NOF) has developed eleven patient-level key performance indicators (KPIs) for fracture liaison services (FLSs) to guide quality improvement. INTRODUCTION Fracture Liaison Services (FLSs) are recommended worldwide to reduce fracture risk after a sentinel fracture. Given not every FLS is automatically effective, the IOF Capture the Fracture working group has developed and implemented the Best Practice Framework to assess the organisational components of an FLS. We have now developed a complimentary KPI set that extends this assessment of performance to the patient level. METHODS The Capture the Fracture working group in collaboration with the Fragility Fracture Network Secondary Fragility Fracture Special Interest Group and National Osteoporosis Foundation adapted existing metrics from the UK-based Fracture Liaison Service Database Audit to develop a patient-level KPI set for FLSs. RESULTS Eleven KPIs were selected. The proportion of patients: with non-spinal fractures; with spine fractures (detected clinically and radiologically); assessed for fracture risk within 12 weeks of sentinel fracture; having DXA assessment within 12 weeks of sentinel fracture; having falls risk assessment; recommended anti-osteoporosis medication; commenced of strength and balance exercise intervention within 16 weeks of sentinel fracture; monitored within 16 weeks of sentinel fracture; started anti-osteoporosis medication within 16 weeks of sentinel fracture; prescribed anti-osteoporosis medication 52 weeks after sentinel fracture. The final KPI measures data completeness for each of the other KPIs. For these indicators, levels of achievement were set at the < 50%, 50-80% and > 80% levels except for treatment recommendation where a level of 50% was used. CONCLUSION This KPI set compliments the existing Best Practice Framework to support FLSs to examine their own performance using patient-level data. By using this KPI set for local quality improvement cycles, FLSs will be able to efficiently realise the full potential of secondary fracture prevention and improved clinical outcomes for their local populations.
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Affiliation(s)
- M K Javaid
- The Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Orthopaedic Sciences, University of Oxford, Oxford, OX4 7LD, UK.
| | - A Sami
- The Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Orthopaedic Sciences, University of Oxford, Oxford, OX4 7LD, UK
| | - W Lems
- VU University Medical Center, Amsterdam, The Netherlands
| | - P Mitchell
- The Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Orthopaedic Sciences, University of Oxford, Oxford, OX4 7LD, UK
- School of Medicine, Sydney Campus, The University of Notre Dame Australia, 140 Broadway, Sydney, NSW, 2007, Australia
| | - T Thomas
- Department of Rheumatology, Hôpital Nord, CHU de Saint-Etienne, and INSERM U1059, University of Lyon, Saint-Etienne, France
| | - A Singer
- Department of Medicine, MedStar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC, USA
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC, USA
| | - R Speerin
- Fragility Fracture Network, Zürich, Switzerland
- Musculoskeletal Network, NSW Agency for Clinical Innovation, Chatswood, Australia
| | - M Fujita
- International Osteoporosis Foundation, Nyon, Switzerland
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - K Akesson
- Department of Orthopaedics, Skane University Hospital, Malmö, Sweden
| | - P Halbout
- International Osteoporosis Foundation, Nyon, Switzerland
| | - S Ferrari
- Division of Bone Disease, Department of Internal Medicine Specialties, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland
| | - C Cooper
- The Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Orthopaedic Sciences, University of Oxford, Oxford, OX4 7LD, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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13
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van den Berg P, Schweitzer DH, van Haard PMM, Geusens PP, van den Bergh JP. The use of pulse-echo ultrasound in women with a recent non-vertebral fracture to identify those without osteoporosis and/or a subclinical vertebral fracture: a pilot study. Arch Osteoporos 2020; 15:56. [PMID: 32291527 DOI: 10.1007/s11657-020-00730-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED A pilot study on the use of P-EU to identify patients without osteoporosis and/or a subclinical vertebral fracture after a recently sustained non-vertebral fracture (NVF). INTRODUCTION Screening with portable devices at emergency departments or plaster rooms could be of interest to limit referrals for dual X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). We calculated the number of negative tests for osteoporosis and/or subclinical vertebral fractures (VFs) using pulse-echo ultrasonometry (P-UE) at different thresholds. PATIENTS AND METHODS In this cross-sectional study, 209 consecutive women of 50-70 years with a recent non-vertebral fracture (NVF) were studied at the Fracture Liaison Service (FLS) of one hospital. All women received DXA/VFA and P-EU (Bindex®) assessments. Various P-EU thresholds (based on the density index (DI, g/cm2)) were analyzed to calculate the best balance between true negative (indeed no osteoporosis and/or subclinical VF) and false negative tests (osteoporosis and/or subclinical VF according to DXA/VFA). RESULTS Eighty-three women had osteoporosis (40%) and 17 women at least one VF (8%). Applying the manufacturer's recommended P-EU threshold (DI 0.844 g/cm2) being their proposed cut-off for not having hip osteoporosis resulted in 77 negative tests (37%, 31% true negative and 6% false negative tests). A DI of 0.896 g/cm2 resulted in 40 negative tests (19.3%) (38 true negative (18.3%) and 2 false negative tests (1.0%)). CONCLUSION The application of P-EU enables the identification of a substantial proportion of women with recent non-vertebral fractures at the FLS who would not need a DXA/VFA referral because they had no osteoporosis and/or subclinical vertebral fractures. The most conservative P-EU threshold resulted in 18.3% true negative tests verified by DXA/VFA against 1% false negative test results.
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Affiliation(s)
- Peter van den Berg
- Department of Orthopedics and Surgery, Fracture Liaison Service, Reinier de Graaf Gasthuis, Delft, the Netherlands.
| | - Dave H Schweitzer
- Department of Internal Medicine and Endocrinology, Reinier the Graaf Gasthuis, Delft, the Netherlands
| | - Paul M M van Haard
- Department of Medical Laboratories, Association of Clinical Chemistry, Reinier the Graaf Gasthuis, Delft, the Netherlands
| | - Piet P Geusens
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
- Hasselt University, Hasselt, Belgium
| | - Joop P van den Bergh
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
- Hasselt University, Hasselt, Belgium
- Department of Internal Medicine, VieCuri Medical Centre Noord-Limburg and Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
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14
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Mitchell PJ, Cooper C, Fujita M, Halbout P, Åkesson K, Costa M, Dreinhöfer KE, Marsh DR, Lee JK, Chan DCD, Javaid MK. Quality Improvement Initiatives in Fragility Fracture Care and Prevention. Curr Osteoporos Rep 2019; 17:510-520. [PMID: 31734907 DOI: 10.1007/s11914-019-00544-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review sought to describe quality improvement initiatives in fragility fracture care and prevention. RECENT FINDINGS A major care gap persists throughout the world in the secondary prevention of fragility fractures. Systematic reviews have confirmed that the Fracture Liaison Service (FLS) model of care is associated with significant improvements in rates of bone mineral density testing, initiation of osteoporosis treatment and adherence with treatment for individuals who sustain fragility fractures. Further, these improvements in the processes of care resulted in significant reductions in refracture risk and lower post-fracture mortality. The primary challenge facing health systems now is to ensure that best practice is delivered effectively in the local healthcare setting. Publication of clinical standards for FLS at the organisational and patient level in combination with the establishment of national registries has provided a mechanism for FLS to benchmark and improve their performance. Major efforts are ongoing at the global, regional and national level to improve the acute care, rehabilitation and secondary prevention for individuals who sustain fragility fractures. Active participation in these initiatives has the potential to eliminate current care gaps in the coming decade.
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Affiliation(s)
- Paul J Mitchell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- School of Medicine, Sydney Campus, The University of Notre Dame Australia, 140 Broadway, Sydney, NSW, 2007, Australia.
- Fragility Fracture Network, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- International Osteoporosis Foundation, 9 rue Juste-Olivier, CH-1260, Nyon, Switzerland
| | - Masaki Fujita
- International Osteoporosis Foundation, 9 rue Juste-Olivier, CH-1260, Nyon, Switzerland
| | - Philippe Halbout
- International Osteoporosis Foundation, 9 rue Juste-Olivier, CH-1260, Nyon, Switzerland
| | - Kristina Åkesson
- International Osteoporosis Foundation, 9 rue Juste-Olivier, CH-1260, Nyon, Switzerland
- Department of Orthopaedics, Skane University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Matthew Costa
- Fragility Fracture Network, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karsten E Dreinhöfer
- Fragility Fracture Network, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland
- Department of Musculoskeletal Rehabilitation, Prevention and Health Service Research, Center for Sport Science and Sport Medicine (CSSB), Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin, Berlin, Germany
- Department of Orthopedics and Traumatology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - David R Marsh
- Fragility Fracture Network, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Joon-Kiong Lee
- Department of Orthopedic Surgery, Beacon International Specialist Centre, Petaling Jaya, Selangor, Malaysia
- Advanced Neuroscience and Orthopedic Centre (ANOC), Kuala Lumpur, Malaysia
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Superintendent Office, Chutung Branch, National Taiwan University Hospital, Hsinchu County, Taiwan
| | - M Kassim Javaid
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- International Osteoporosis Foundation, 9 rue Juste-Olivier, CH-1260, Nyon, Switzerland
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