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Jones AR, Enticott JE, Ebeling PR, Mishra GD, Teede HJ, Vincent AJ. Geographic Variation in Osteoporosis Treatment in Postmenopausal Women: A 15-Year Longitudinal Analysis. J Endocr Soc 2024; 8:bvae127. [PMID: 39035035 PMCID: PMC11258558 DOI: 10.1210/jendso/bvae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Indexed: 07/23/2024] Open
Abstract
Context Osteoporosis affects more than half of older women, but many are not treated. Whether treatment differs between rural and urban areas is unknown. Objective To examine differences in osteoporosis treatment among postmenopausal women living in urban and rural areas of Australia. Methods Women participating in the Australian Longitudinal Study on Women's Health, a prospective longitudinal cohort study, born between 1946-1951, and with osteoporosis or fractures, were included. Surveys from 2004 to 2019 were linked to the Pharmaceutical Benefits Scheme (government-subsidized medications) to assess osteoporosis treatment and adherence, comparing geographical areas. Results Of the 4259 women included (mean age, 55.6 years), 1703 lived in major cities, 1629 inner regional, 794 outer regional, and 133 remote areas. Over the 15-year follow-up, 1401 (32.9%) women received treatment, including 47.4% of women with osteoporosis and 29.9% with fractures. Women in outer regional and remote areas were less likely to use antiosteoporosis treatment than those in major cities on univariable analysis (outer regional odds ratio, 0.83; 95% CI, 0.72-0.95; remote, 0.65; 0.49-0.86), but this did not remain significant on multivariable analysis. Median duration of use was 10 to 36 months, adherence varied by treatment type (34%-100%) but was not related to incident fractures, and of the women who stopped denosumab, 85% did not receive another consolidating treatment. Conclusions One-third of women with osteoporosis/fractures received treatment, and adherence was low. There was no difference in treatment use between urban and rural areas after adjusting for risk factors, although the specific treatment used, and adherence, differed.
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Affiliation(s)
- Alicia R Jones
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia, 3168
- Department of Endocrinology, Monash Health, Melbourne, Australia, 3168
| | - Joanne E Enticott
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia, 3168
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, Melbourne, Australia, 3168
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia, 3168
| | - Gita D Mishra
- Australian Women and Girls’ Health Research Centre, School of Public Health, University of Queensland, Brisbane, Australia, 4006
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia, 3168
- Department of Endocrinology, Monash Health, Melbourne, Australia, 3168
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia, 3168
- Department of Endocrinology, Monash Health, Melbourne, Australia, 3168
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Carbonell-Abella C, Torguet Carbonell J, Martínez Martí M. [Adherence in the pharmacological treatment of osteoporosis]. Med Clin (Barc) 2024; 162:e59-e63. [PMID: 38614904 DOI: 10.1016/j.medcli.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Cristina Carbonell-Abella
- Medicina Familiar y Comunitaria, Centro de Salud Vía Roma, Barcelona, España; Departamento de Medicina, Universidad de Barcelona, Barcelona, España.
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Toro G, Braile A, Liguori S, Moretti A, Landi G, Cecere AB, Conza G, De Cicco A, Tarantino U, Iolascon G. The role of the fracture liaison service in the prevention of atypical femoral fractures. Ther Adv Musculoskelet Dis 2023; 15:1759720X231212747. [PMID: 38035253 PMCID: PMC10685792 DOI: 10.1177/1759720x231212747] [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: 03/16/2023] [Accepted: 09/29/2023] [Indexed: 12/02/2023] Open
Abstract
Osteoporosis and fragility fractures (FFs) are considered critical health problems by the World Health Organization (WHO) because of high morbidity, mortality, and healthcare costs. The occurrence of a FF raises the risk of a subsequent fracture (refracture). The hip is the most common site of fragility refracture, and its onset is associated with a further increase in patient's morbidity, mortality, and socioeconomic burden. Therefore, the prevention of refracture is essential. In this context, fracture liaison service (FLS) demonstrated to be able to reduce FF risk and also improve patients' adherence to anti-osteoporotic treatments, particularly for bisphosphonates (BPs). However, long-term and high adherence to BPs may lead to atypical femoral fractures (AFFs). These latter are tensile side stress fractures of the femur, with high rates of complications, including delayed and non-healing. An effective FLS should be able to prevent both FF and AFF. A comprehensive and interdisciplinary approach, through the involvement and education of a dedicated team of healthcare professionals (i.e. orthopedic, geriatrician, primary care physician, rehabilitation team, and bone nurse) for evaluating both FF and AFF risks might be useful to improve the standard of care.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, Naples 80138, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Unit of Orthopaedics and Traumatology, Ospedale del Mare, Naples, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Landi
- Unit of Orthopaedics and Traumatology, Santa Maria della Speranza Hospital, Battipaglia, Italy
| | | | - Gianluca Conza
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Unit of Orthopaedics and Traumatology, Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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4
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Yan C, Chen Y, Cao J, Fang K, Shao L, Luo Y, Yang L. The effectiveness of fracture liaison services in patients with hip fractures: A systematic review and meta-analysis of randomized controlled trials. Heliyon 2023; 9:e20838. [PMID: 37867909 PMCID: PMC10585289 DOI: 10.1016/j.heliyon.2023.e20838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
Background In recent years, fracture liaison services (FLS) have been applied for hip fractures; however, their effectiveness remains uncertain. Objective To evaluate the effectiveness of FLS in patients with hip fractures. Design A systematic review and meta-analysis of randomized controlled trials. Data sources Embase, PubMed, Cochrane Library, Ebsco, Ovid, Web of Science, Medline, CNKI, Wangfang, and Vip were searched from their date of inception to March 2023. Two researchers screened the literature based on the inclusion and exclusion criteria, evaluated the quality, extracted data, and conducted a meta-analysis using ReviewManager 5.4. Results After screening, 12 randomised controlled trials (RCT) including 2136 patients were used in the meta-analysis. The primary outcomes were hip function rate of recurrent fracture, medication adherence, and degree of weakness. FLS improved hip function in patients with hip fractures [MD = 9.37, 95 % CI (7.69, 11.06), P < 0.0001], P < 0.0001], medication adherence [OR = 10.59, 95 % CI (1.64, 68.41), P<0.0001], degree of weakness [MD = -1.45, 95%CI (-1.68,-1.23), P<0.0001], and reduced the rate of recurrent fractures [OR = 0.60, 95 % CI (0.44, 0.82). Conclusion Implementation of the FLS management model was beneficial for patients with hip fractures. It can positively impact the prognosis of patients with hip fractures by improving hip function, reducing the rate of recurrent fractures, and improving medication adherence and degree of weakness.
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Affiliation(s)
- Chengli Yan
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yuyu Chen
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jia Cao
- Nursing Department, Dazhou Central Hospital, Sichuan, China
| | - Kai Fang
- Department of Information, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Lifang Shao
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yaping Luo
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Lili Yang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
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Chen YP, Chang WC, Wen TW, Chien PC, Huang SW, Kuo YJ. Multipronged Programmatic Strategy for Preventing Secondary Fracture and Facilitating Functional Recovery in Older Patients after Hip Fractures: Our Experience in Taipei Municipal Wanfang Hospital. Medicina (B Aires) 2022; 58:medicina58070875. [PMID: 35888594 PMCID: PMC9315530 DOI: 10.3390/medicina58070875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: The study assessed the effectiveness of a fracture liaison service (FLS) after 1 year of implementation in improving the outcomes of hip fracture surgery in older adult patients at Taipei Municipal Wanfang Hospital. Materials and Methods: The Wanfang hospital’s FLS program was implemented using a multipronged programmatic strategy. The aims were to encourage the screening and treatment of osteoporosis and sarcopenia, to take a stratified care approach for patients with a high risk of poor postoperative outcomes, and to offer home visits for the assessment of environmental hazards of falling, and to improve the patient’s adherence to osteoporosis treatment. The clinical data of 117 and 110 patients before and after FLS commencement, respectively, were collected from a local hip fracture registry; the data were analyzed to determine the outcomes 1 year after hip fracture surgery in terms of refracture, mortality, and activities of daily living. Results: The implementation of our FLS significantly increased the osteoporosis treatment rate after hip fracture surgery from 22.8% to 72.3%, significantly decreased the 1-year refracture rate from 11.8% to 4.9%, non-significantly decreased 1-year mortality from 17.9% to 11.8%, and improved functional outcomes 1 year after hip fracture surgery. Conclusions: Implementation of our FLS using the multipronged programmatic strategy effectively improved the outcomes and care quality after hip fracture surgery in the older adult population, offering a successful example as a valuable reference for establishing FLS to improve the outcomes in vulnerable older adults.
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Affiliation(s)
- Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-P.C.); (W.-C.C.); (P.-C.C.); (S.-W.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Wei-Chun Chang
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-P.C.); (W.-C.C.); (P.-C.C.); (S.-W.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Tsai-Wei Wen
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
| | - Pei-Chun Chien
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-P.C.); (W.-C.C.); (P.-C.C.); (S.-W.H.)
| | - Shu-Wei Huang
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-P.C.); (W.-C.C.); (P.-C.C.); (S.-W.H.)
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-P.C.); (W.-C.C.); (P.-C.C.); (S.-W.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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6
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Naranjo A, Molina A, Quevedo A, Rubiño FJ, Sánchez-Alonso F, Rodríguez-Lozano C, Ojeda S. Long-term persistence of treatment after hip fracture in a fracture liaison service. Sci Rep 2022; 12:9373. [PMID: 35672434 PMCID: PMC9174234 DOI: 10.1038/s41598-022-13465-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
Long-term adherence to antiosteoporosis medication (AOM) in the setting of a fracture liaison service (FLS) are not well known. Patients ≥ 50 with hip fracture seen in an FLS and recommended for treatment to prevent new fractures were analyzed. Baseline data included demographics, identification mode, previous treatment and FRAX items. Patient records were reviewed 3-8 years later, and these data were collected: (1) survival; (2) major refracture; (3) initiation of treatment, proportion of days covered (PDC) and persistence with AOM. 372 patients (mean age, 79 years; 76% women) were included. Mean follow-up was 47 months, 52 patients (14%) had a refracture (22 hip) and 129 (34.5%) died. AOM was started in 283 patients (76.0%). Factors associated with initiation of AOM were previous use of bisphosphonate (OR 9.94; 95% CI 1.29-76.32) and a lower T-score lumbar (OR 0.80; 95% CI 0.65-0.99). Persistence decreased to 72.6%, 60% and 47% at 12, 36 and 60 months. A PDC > 80% was confirmed in 208 patients (55.7%) and associated with previous use of bisphosphonate (OR 3.38; 95% CI 1.34-8.53), treatment with denosumab (OR 2.69; 95% CI:1.37-5.27), and inpatient identification (OR 2.26; 95% CI 1.18-4.34). Long-term persistence with AOM was optimal in patients with hip fracture seen at an FLS. A PDC > 80% was associated with inpatient identification and prescription of denosumab.
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Affiliation(s)
- Antonio Naranjo
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de La Ballena, 35011, Las Palmas, Spain. .,University of Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Amparo Molina
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de La Ballena, 35011, Las Palmas, Spain
| | - Adrián Quevedo
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de La Ballena, 35011, Las Palmas, Spain
| | - Francisco J Rubiño
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de La Ballena, 35011, Las Palmas, Spain
| | | | - Carlos Rodríguez-Lozano
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de La Ballena, 35011, Las Palmas, Spain
| | - Soledad Ojeda
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de La Ballena, 35011, Las Palmas, Spain
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Kobayashi S, Tanaka S, Yoshino Y, Tobita H, Kuwagaki K, Fujioka R, Totsuka H, Ichiba Y, Ishimine S, Sakamoto K, Ohama H, Kubo T. Impact of osteoporosis liaison services on the expected lifetime osteoporosis-related medical expenses of patients with fragility fracture in a private hospital in Japan. Arch Osteoporos 2022; 17:64. [PMID: 35416539 DOI: 10.1007/s11657-022-01101-0] [Citation(s) in RCA: 2] [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: 08/06/2021] [Accepted: 03/18/2022] [Indexed: 02/03/2023]
Abstract
We report the efficacy of a Japanese fracture liaison service (FLS), the osteoporosis liaison service (OLS), in suppressing osteoporosis-related expenses from the public insurance by preventing secondary fracture in spite of higher medication costs during expected life spans. OLS could reduce medical expenses for osteoporosis in all age groups. PURPOSE Osteoporosis liaison services (OLS), which are based on fracture liaison services (FLS), are used in Japan to prevent both primary and secondary fractures in older people. We aimed to clarify the effects of OLS on the medical expenses. PATIENTS AND METHODS We compared patients with fragile fractures hospitalized to Saitama Jikei Hospital before and after implementing OLS. These were labeled a non-OLS group and an OLS group, and they were further organized by age (< 75, 75-84, and ≥ 85 years). The expected osteoporosis-related medical expenses during life were calculated by the occurrence, fracture site, medication, and life expectancy and compared between the non-OLS and OLS groups by the age group. RESULTS The non-OLS group included 400 people (100 males and 300 females, mean age 81.7 ± 9.7 years), comprising 154 with vertebral fractures and 246 with hip fractures. The OLS group included 406 patients (101 males and 305 females, mean age 82.4 ± 9.3 years), of whom 161 had vertebral fractures and 245 had hip fractures. The suppressive secondary fracture effects of OLS were previously reported. The expected expense of osteoporosis treatment in the OLS group was found to be greater than that in the non-OLS group for all age groups. In contrast, expected expenses for treating secondary fractures were shown to increase more in the non-OLS group. However, total expenses were lower in the OLS group across all age groups. CONCLUSION The implementation of OLS can reduce overall healthcare costs despite the increased expenses required to provide medical therapy and periodic examinations.
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Affiliation(s)
- Saori Kobayashi
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
| | - Shinya Tanaka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan.
- Department of Orthopaedic Surgery, Saitama Northern Medical Center, Japan Community Health Organization, 851, Miyahara 1 chome, Kita-ku, Saitama-city, Saitama, 331-8625, Japan.
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan.
- Department of Orthopedic Surgery, Saitama Jikei Hospital, Saitama, Japan.
| | - Yasumasa Yoshino
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Orthopedic Surgery, Saitama Jikei Hospital, Saitama, Japan
| | - Hideki Tobita
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Rehabilitation, Saitama Jikei Hospital, Saitama, Japan
| | - Kanae Kuwagaki
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Rehabilitation, Saitama Jikei Hospital, Saitama, Japan
| | - Rie Fujioka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Nutrition of Saitama Jikei Hospital, Saitama, Japan
| | - Hiroaki Totsuka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Pharmacy of Saitama Jikei Hospital, Saitama, Japan
| | - Yuka Ichiba
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Nursing Department of Saitama Jikei Hospital, Saitama, Japan
| | - Sachiko Ishimine
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Nursing Department of Saitama Jikei Hospital, Saitama, Japan
| | - Kazumi Sakamoto
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Radiology, Saitama Jikei Hospital, Saitama, Japan
| | - Hikaru Ohama
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Orthopedic Surgery, Saitama Jikei Hospital, Saitama, Japan
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Sanders E, Dobransky J, Cheaitani L, Harris N, Liew A, Papp S, Grammatopoulos G. Preventing hip fractures with multidisciplinary teams: a Canadian perspective. Can J Surg 2021; 64:E310-E316. [PMID: 34038059 PMCID: PMC8327994 DOI: 10.1503/cjs.014219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fragility fractures (FFs) are low-energy trauma fractures that occur at or below standing height. Among FFs, hip fractures are associated with the greatest morbidity, mortality and cost to Canadian health care systems. This review highlights the current state of medical care for hip fractures in Canada, with specific focus on the role of the multidisciplinary team. Gaps in care exist, as FFs represent a unique challenge requiring both acute and chronic management. Furthermore, there is a lack of ownership of FFs by a medical specialty. These gaps can be addressed through the use of multidisciplinary teams, which have been shown to be efficacious and cost-effective. This model of care also addresses numerous patient-identified barriers to treatment, including inadequate patient counselling. However, there is still room for improvement in both the identification of patients at risk for hip fracture and patient adherence to therapy.
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Affiliation(s)
- Ethan Sanders
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Sanders); the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Dobransky, Liew, Papp, Harris, Grammatopoulos); and the Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Cheaitani)
| | - Johanna Dobransky
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Sanders); the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Dobransky, Liew, Papp, Harris, Grammatopoulos); and the Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Cheaitani)
| | - Lara Cheaitani
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Sanders); the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Dobransky, Liew, Papp, Harris, Grammatopoulos); and the Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Cheaitani)
| | - Nicole Harris
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Sanders); the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Dobransky, Liew, Papp, Harris, Grammatopoulos); and the Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Cheaitani)
| | - Allan Liew
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Sanders); the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Dobransky, Liew, Papp, Harris, Grammatopoulos); and the Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Cheaitani)
| | - Steven Papp
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Sanders); the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Dobransky, Liew, Papp, Harris, Grammatopoulos); and the Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Cheaitani)
| | - George Grammatopoulos
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Sanders); the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Dobransky, Liew, Papp, Harris, Grammatopoulos); and the Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Cheaitani)
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9
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Yoshino Y, Tanaka S, Ohama H, Kobayashi S, Tobita H, Kuwagaki K, Fujioka R, Totsuka H, Ichiba Y, Ishimine S, Sakamoto K, Kubo T. Effectiveness of a Japanese multi-professional cooperative osteoporosis liaison service at a private hospital for decreasing secondary fractures in osteoporosis patients with fragility fractures. Arch Osteoporos 2021; 16:75. [PMID: 33890181 DOI: 10.1007/s11657-021-00924-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE A fracture liaison service (FLS) was established in England to support patients with fragility fractures, and it was introduced in Japan as the osteoporosis liaison service (OLS). The study aim was to determine if the Japanese OLS/FLS prevents secondary fractures in patients with fragility fractures and assess the value of the OLS/FLS. Our OLS/FLS evaluated the status of osteoporosis in patients and their life circumstances. Additionally, it introduced osteoporosis therapies during the patients' hospitalization period and then continued periodical examinations and prescription of drug after discharge. PATIENTS AND METHODS This study was conducted in consecutive patients: 400 were assigned to the non-OLS group and 406 to the OLS group. The mean age of the patients was 81.7 ± 9.7 years in the non-OLS group (154 patients with vertebral fractures and 246 with hip fractures; 100 males, 300 females) and 82.4 ± 9.3 years in the OLS group (245 patients with hip fractures and 161 with vertebral fractures; 101 males, 305 females). RESULTS During hospitalization, 74.9% of the OLS group patients started medications and 63.9% of patients continued after discharge, while 35.8% and 53.5% of non-OLS group. The incidence rate of secondary fractures was 89.8/1000 person-years in the non-OLS group, and 55.2/1000 person-years in the OLS group. The multivariate Cox hazards test showed that secondary fractures after vertebral or hip fractures increased with age, and the risk was 0.58-fold in patients in the OLS group. CONCLUSION OLS was effective in reducing secondary fractures in patients with osteoporosis with fragility fractures.
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Affiliation(s)
- Yasumasa Yoshino
- Department of Orthopaedic Surgery, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Shinya Tanaka
- Department of Orthopaedic Surgery, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan. .,Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan. .,Department of Orthopaedic Surgery, Saitama Medical University, Morohongo 38, Moroyama-cho, Iruma-gun, 350-0495, Saitama, Japan.
| | - Hikaru Ohama
- Department of Orthopaedic Surgery, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Saori Kobayashi
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Hideki Tobita
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Department of Rehabilitation, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Kanae Kuwagaki
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Department of Rehabilitation, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Rie Fujioka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Nutrition of Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Hiroaki Totsuka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Pharmacy of Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Yuka Ichiba
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Nursing Department, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Sachiko Ishimine
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Nursing Department, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Kazumi Sakamoto
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Department of Radiology, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Toshiro Kubo
- Director of Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
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10
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Naranjo A, Molina A, Quevedo A, Rubiño FJ, Sánchez-Alonso F, Rodríguez-Lozano C, Ojeda S. Fracture liaison service model: treatment persistence 5 years later. Arch Osteoporos 2021; 16:60. [PMID: 33813663 DOI: 10.1007/s11657-021-00925-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/15/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We analyzed the long-term persistence of treatment in a FLS. During follow-up, 15.2% of patients had a refracture and 23.8% died. At the 5-year checkup, 74% had started treatment (associated with female sex, previous use of bisphosphonate, and referral to an osteoporosis clinic). Persistence at 1 and 5 years was 70.6% and 46.5%, respectively. INTRODUCTION To analyze the long-term persistence of treatment in a fracture liaison service (FLS). METHODS Patients ≥ 50 years with a fragility fracture attended between 2012 and 2016 who were recommended for treatment to prevent new fractures were included. Baseline data included demographics, type of fracture, previous treatment, and FRAX® items. Five years later, patient records were reviewed and the following data were collected: [1] survival; [2] refracture; [3] initiation of treatment, persistence, and medication possession ratio (MPR) > 80%. RESULTS We included 888 patients, mean age 75 years, 83% women, and mean follow-up 56 months. During follow-up, 135 patients (15.2%) had a refracture (109 major fractures, 50 hip refractures) and 212 patients died (23.8%); at the 5-year checkup, 657 patients (74%) had started some type of treatment. Factors associated with the start of treatment were female sex (OR 2.10; 95% CI: 1.42-3.11), previous use of bisphosphonate (OR 3.91; 95% CI: 2.23-6.86), and referral to an osteoporosis clinic (OR 1.46; 95% CI: 1.02-2.07). Persistence decreased from 70.6% at 12 months to 46.5% at 60 months. An MPR > 80% was confirmed in 449 patients, 68.3% of whom were under treatment. A total of 521 and 447 patients received treatment for at least 24 and 36 months, respectively (79.3% and 68.0% of those who started treatment). CONCLUSIONS Patients with fragility fractures attended at an FLS showed optimal long-term persistence of treatment. These data can help healthcare managers better calculate the cost-effectiveness of implementing the FLS model.
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Affiliation(s)
- Antonio Naranjo
- Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35011, Las Palmas, Spain. .,University of Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Amparo Molina
- Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35011, Las Palmas, Spain
| | - Adrián Quevedo
- Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35011, Las Palmas, Spain
| | - Francisco J Rubiño
- Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35011, Las Palmas, Spain
| | | | - Carlos Rodríguez-Lozano
- Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35011, Las Palmas, Spain
| | - Soledad Ojeda
- Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35011, Las Palmas, Spain
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11
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Delbar A, Pflimlin A, Delabrière I, Ternynck C, Chantelot C, Puisieux F, Cortet B, Paccou J. Persistence with osteoporosis treatment in patients from the Lille University Hospital Fracture Liaison Service. Bone 2021; 144:115838. [PMID: 33385615 DOI: 10.1016/j.bone.2020.115838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/07/2020] [Accepted: 12/28/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE/INTRODUCTION A Fracture Liaison Service (FLS) was set up at Lille University Hospital in 2016. The purpose of this study was to assess persistence with osteoporosis treatment in patients from the FLS over a period of 1 year, and to determine predictors of discontinuation. METHODS The study population comprised adults of both genders, aged 50 or over, admitted to Lille University Hospital between January 2016 and January 2019 for a low-trauma fracture and managed in our FLS. Outcomes included (1) persistence rate at 1 year after treatment initiation, (2) persistence rate at 2 years after treatment initiation, (3) persistence rate at 1 and 2 years after treatment initiation according to type of treatment, (4) predictors of non-persistence, and (5) reasons for discontinuing treatment over 1 year after initiation. Persistence was determined using the Kaplan-Meier method. RESULTS In all, 1224 patients (≥50 years old) with a recent history of low-trauma fracture (≤12 months) were identified. Of these, 380 patients - 79.2% female; mean (SD) age 76 (11) years - were seen at the FLS. In those 380 patients, 410 fractures were found and 360 of them (87.8%) were major fractures, breaking down as follows: vertebra (44%), hip (19%), proximal humerus (10%), and pelvis (8%). Osteoporosis treatment was prescribed for 367 (96.6%) patients and 275 of them began the prescribed treatment. The following anti-osteoporosis drugs were prescribed: zoledronic acid (n=150, 54.5%), teriparatide (n=63, 22.9%), and denosumab (n=39, 14.2%). Oral bisphosphonates were prescribed for a few patients (n=23, 8.4%). Persistence with osteoporosis medication (any class) was estimated at 84.1% (95% CI: 79.1% to 88.1%) at 12-month follow-up, and dropped to 70.3% (95% CI: 63.7% to 75.9%) at 24 months. When drug-specific analyses were performed using the Kaplan-Meier method, persistence rates at 12 and 24 months were found to be higher with denosumab than with any other treatment. Independent predictors of non-persistence at 12 months were 'follow-up performed by a general practitioner (GP)' - Odds Ratio (OR) for GP vs. FLS = 3.68; 95% CI, 1.52 to 8.90, p=0.004 - and 'treatment with zoledronic acid' - OR for zoledronic acid vs. denosumab = 3.39; 95% CI, 1.21 to 9.50, p=0.019; OR for zoledronic acid vs. teriparatide = 8.86; 95% CI, 1.15 to 68.10, p=0.035. CONCLUSIONS This study provides evidence of the success of our FLS in terms of long-term persistence with osteoporosis treatments. However, osteoporosis treatment initiation still needs to be improved.
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Affiliation(s)
- Anthony Delbar
- Univ. Lille, CHU Lille, Department of Rheumatology, 59000 Lille, France.
| | - Arnaud Pflimlin
- Univ. Lille, CHU Lille, Department of Rheumatology, 59000 Lille, France.
| | | | - Camille Ternynck
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
| | | | - François Puisieux
- Univ. Lille, CHU Lille, Department of Gerontology, 59000 Lille, France.
| | - Bernard Cortet
- Univ. Lille, CHU Lille, MABlab ULR 4490, Department of Rheumatology, 59000 Lille, France.
| | - Julien Paccou
- Univ. Lille, CHU Lille, MABlab ULR 4490, Department of Rheumatology, 59000 Lille, France.
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12
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Senay A, Fernandes JC, Delisle J, Morin SN, Dragomir A, Nazha S, Perreault S. Patient Healthcare Trajectory and its Impact on the Cost-Effectiveness of Fracture Liaison Services. J Bone Miner Res 2021; 36:459-468. [PMID: 33484586 DOI: 10.1002/jbmr.4216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/01/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
This study aimed to assess the cost-utility of a Fracture Liaison Service (FLS) with a systematic follow-up according to patients' follow-up compliance trajectories. The Lucky Bone™ FLS is a prospective cohort study conducted on women and men (≥40 years) with fragility fractures. Dedicated personnel of the program identified fractures, investigated, treated, and followed patients systematically over 2 years. Groups of follow-up compliance trajectories were identified, and Markov decision models were used to assess the cost-utility of each follow-up trajectory group compared to usual care. A lifetime horizon from the perspective of the healthcare payer was modeled. Costs were converted to 2018 Canadian dollars and incremental cost-utility ratios (ICURs) were measured. Costs and benefits were discounted at 1.5%. A total of 532 participants were followed in the FLS (86% women, mean age of 63 years). Three trajectories were predicted and interpreted; the high followers (HFs, 48.4%), intermediate followers (IFs, 28.1%), and low followers (LFs, 23.5%). The costs of the interventions per patient varied between $300 and $446 for 2 years, according to the follow-up trajectory. The FLS had higher investigation, treatment, and persistence rates compared to usual care. Compared to usual care, the ICURs for the HF, IF, and LF trajectory groups were $4250, $21,900, and $72,800 per quality-adjusted life year (QALY) gained, respectively ($9000 per QALY gained for the overall FLS). Sensitivity analyses showed that the HF and IF trajectory groups, as well as the entire FLS, were cost-effective in >67% of simulations with respect to usual care. In summary, these results suggest that a high-intensity FLS with a systematic 2-year follow-up can be cost-effective, especially when patients attend follow-up visits. They also highlight the importance of understanding the behaviors and factors that surround follow-up compliance over time as secondary prevention means that they are at high risk of re-fracture. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Andréa Senay
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada.,CIUSSS Nord de l'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Julio C Fernandes
- CIUSSS Nord de l'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,CIUSSS Nord de l'Ile de Montréal, Hôpital Jean-Talon, Montréal, QC, Canada
| | - Josée Delisle
- CIUSSS Nord de l'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,CIUSSS Nord de l'Ile de Montréal, Hôpital Jean-Talon, Montréal, QC, Canada
| | - Suzanne N Morin
- Center for Outcomes and Evaluation, Department of Medicine, McGill University, Montréal, QC, Canada
| | - Alice Dragomir
- Department of Surgery, Division of Urology, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Sara Nazha
- Department of Surgery, Division of Urology, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada.,Sanofi Aventis endowment Research Chair in Optimal Drug Use, Université de Montréal, Montréal, QC, Canada
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13
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Adachi JD, Brown JP, Schemitsch E, Tarride JE, Brown V, Bell AD, Reiner M, Packalen M, Motsepe-Ditshego P, Burke N, Slatkovska L. Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada. BMC Musculoskelet Disord 2021; 22:224. [PMID: 33637078 PMCID: PMC7908684 DOI: 10.1186/s12891-021-04051-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The secondary fracture prevention gap in the osteoporosis field has been previously described as a 'crisis'. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1-2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures. METHODS This retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged > 65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized. RESULTS Among 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555 days (interquartile range: 236-955). For each index fracture site examined, median time from index to second fracture was < 2 years. The proportion of patients with BMD assessment was 10.3% ≤1 year prior to and 16.4% ≤1 year post index fracture. The proportion of patients receiving osteoporosis therapy was 29.8% ≤1 year prior, 34.6% ≤1 year post, and 25.9% > 3 years post index fracture. CONCLUSIONS This cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated.
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Affiliation(s)
| | - Jacques P Brown
- CHU de Québec Research Centre and Laval University, Québec, QC, Canada
| | - Emil Schemitsch
- Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health, The Research Institute of St. Joe's Hamilton, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Vivien Brown
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Alan D Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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14
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Mugnier B, Daumas A, Doddoli S, Belmeliani S, Couderc AL, Mizzi B, Lévêque P, Villani P. Adherence to fracture liaison service programs in patients over 70: the hidden part of the iceberg. Osteoporos Int 2020; 31:765-774. [PMID: 31927612 DOI: 10.1007/s00198-020-05290-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
UNLABELLED Significant dropout rates have been observed throughout Fracture Liaison Service (FLS) programs, especially for elderly patients. In an FLS program set up specifically for patients over 70, the non-initiation of osteoporosis treatment was the only factor associated with poor adherence to the program. Neither age nor frailty factors affected adherence. INTRODUCTION FLS programs are considered the most effective interventions for secondary prevention of osteoporotic fractures. Our objective was to identify risk factors for non-adherence to an FLS program set up specifically for patients over 70. METHODS Our multifaceted, intensive program included five appointments over a 2-year period. One hundred sixty-seven patients (mean age 83.5 years) who presented with a recent fragility fracture were enrolled. Multivariable analysis was conducted to determine whether the demographic, clinical, frailty, and osteoporotic risk factors of the patients influenced their adherence to the program. RESULTS About half of the patients did not attend the follow-up visits. According to the regression analysis, non-initiation of osteoporosis treatment was associated with poor adherence to the program (aHR 3.66). Demographic, clinical, dwelling, frailty factors, osteoporotic risk factors, fracture type, or densitometric scores were not associated with adherence. The first self-reported reason for withdrawal was the difficulty of attending several follow-up visits, and the second was the feeling of not being concerned. CONCLUSION We observed that non-initiation of osteoporosis treatment was the only factor correlated with non-adherence to an FLS program. Thus, neither age nor frailty factors should result in patients not being included in FLS. Beyond the necessity of the osteoporosis treatment, good patient understanding of the relevance of all the interventions included in the program is the key.
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Affiliation(s)
- B Mugnier
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France.
| | - A Daumas
- APHM, Hôpital La Timone, Service de Médecine Interne Gériatrie et Thérapeutique, 264 rue Saint Pierre, 13005, Marseille, France
| | - S Doddoli
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - S Belmeliani
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - A-L Couderc
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - B Mizzi
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - P Lévêque
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
| | - P Villani
- APHM, Hôpital Sainte Marguerite, Service de Médecine Interne Gériatrie et Thérapeutique, 270 Bd de Sainte Marguerite, 13009, Marseille, France
- APHM, Hôpital La Timone, Service de Médecine Interne Gériatrie et Thérapeutique, 264 rue Saint Pierre, 13005, Marseille, France
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