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El Miedany Y, Hasab El Naby MM, Abu-Zaid MH, Mahran S, Eissa M, Saber HG, Tabra SA, Ibrahim RA, Galal S, Elwakil W. Post-fracture care program in Egypt: merging subsequent fracture prevention and improving patients’ outcomes—an initiative by the Egyptian Academy of Bone Health. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-023-00173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Abstract
Background
Despite the associated high prevalence of morbidity and mortality, osteoporotic fragility fractures remain underdiagnosed and undertreated. Furthermore, those who sustain a fragility fracture are at imminent risk of sustaining subsequent fractures. Post-fracture care (PFC) programs are systematic, coordinated care programs that recognize, evaluate, and manage older adults who sustained a fragility fracture with the goal of managing all the risk factors and preventing succeeding fractures.
Main text
This work was carried out to outline the PFC program adopted in Egypt and its applicability in standard clinical practice. A review of literature was conducted to identify an evidence-informed PFC strategies and protocols, which outlines the optimal manner to manage older adults living with fragility fractures. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to guide the reporting of this review. Based on this, a PFC integrated model of care based on a patient-centered approach has been developed aiming to optimize the outcomes.
Conclusion
This manuscript described the integrated model of care adopted in Egypt to provide care for older adults presenting with fragility fractures. This will pave the way to standardize patient identification and management. Additionally, to prevent occurrence of subsequent fractures and to enhance equity of care for patients with fragility fracture and osteoporosis, expansion of such service to rural and remote areas is highly recommended.
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Åkesson KE, Ganda K, Deignan C, Oates MK, Volpert A, Brooks K, Lee D, Dirschl DR, Singer AJ. Post-fracture care programs for prevention of subsequent fragility fractures: a literature assessment of current trends. Osteoporos Int 2022; 33:1659-1676. [PMID: 35325260 PMCID: PMC8943355 DOI: 10.1007/s00198-022-06358-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/18/2022] [Indexed: 01/07/2023]
Abstract
Post-fracture care (PFC) programs evaluate and manage patients with a minimal trauma or fragility fracture to prevent subsequent fractures. We conducted a literature review to understand current trends in PFC publications, evaluate key characteristics of PFC programs, and assess their clinical effectiveness, geographic variations, and cost-effectiveness. We performed a search for peer-reviewed articles published between January 2003 and December 2020 listed in PubMed or Google Scholar. We categorized identified articles into 4 non-mutually exclusive PFC subtopics based on keywords and abstract content: PFC Types, PFC Effectiveness/Success, PFC Geography, and PFC Economics. The literature search identified 784 eligible articles. Most articles fit into multiple PFC subtopics (PFC Types, 597; PFC Effectiveness/Success, 579; PFC Geography, 255; and PFC Economics, 98). The number of publications describing how PFC programs can improve osteoporosis treatment rates has markedly increased since 2003; however, publication gaps remain, including low numbers of publications from some countries with reported high rates of osteoporosis and/or hip fractures. Fracture liaison services and geriatric/orthogeriatric services were the most common models of PFC programs, and both were shown to be cost-effective. We identified a need to expand and refine PFC programs and to standardize patient identification and reporting on quality improvement measures. Although there is an increasing awareness of the importance of PFC programs, publication gaps remain in most countries. Improvements in established PFC programs and implementation of new PFC programs are still needed to enhance equitable patient care to prevent occurrence of subsequent fractures.
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Affiliation(s)
- K E Åkesson
- Faculty of Medicine, Lund University, Malmö, Sweden.
- Department of Orthopedics, Skåne University Hospital, Inga Marie Nilssons gata 22, S-205 02, Malmö, Sweden.
| | - K Ganda
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Endocrinology, Concord Repatriation General Hospital, Sydney, Australia
| | - C Deignan
- Global Clinical Development, Amgen Inc., CA, Thousand Oaks, USA
| | - M K Oates
- Global Clinical Development, Amgen Inc., CA, Thousand Oaks, USA
| | - A Volpert
- BioScience Communications, New York, NY, USA
| | | | - D Lee
- Global Marketing, Amgen Inc., Thousand Oaks, CA, USA
- Health Collaboration Partners LLC, Thousand Oaks, CA, USA
| | - D R Dirschl
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - A J Singer
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA
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Moral-Cuesta D, Gutiérrez-Misis A, Veloz BAC, Matovelle-Ochoa P, Epelde IM, Alarcón TA, Díez-Sebastián J, Galbete A, Maestre IM, Velilla NM, González-Montalvo JI. Profile and 3-month evolution of geriatric patients after a hip fracture followed-up at a Fracture Liaison Service (FLS). Rev Esp Geriatr Gerontol 2022; 57:205-211. [PMID: 35872030 DOI: 10.1016/j.regg.2022.06.006] [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] [Received: 10/17/2021] [Revised: 05/29/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are few studies on Fracture Liaison Service (FLS) that evaluate older patients after a hip fracture (HF) through comprehensive geriatric assessment. We aim to determine these patients' characteristics, outcomes, and prescribed treatments. METHODS A retrospective observational study of a cohort of patients older than 65 years admitted with HFs to an orthogeriatric unit between February 25th (2013) and December 16th (2016). After hospitalization, those patients with a good baseline social, functional, and cognitive situation were referred to the FLS. A comprehensive geriatric assessment and treatment adjustment were conducted. A comparison between FLS patients and HF patients non-referred was made. RESULTS From 1887 patients admitted to the orthogeriatric unit, 469 (23%) were referred to the FLS. Of those, 335 were women (77.2%) and 337 (77.6%) lived in the community. The FLS patients had a better functional status (97.1% of the patients with independent gait versus 79.2%) than non-FLS patients (p<0.001). After 3 months in the FLS, 356 (82%) patients had independent gait and had improved their analytical values. Antiosteoporotic treatment was prescribed to 322 patients (74%), vitamin D supplements to 397 (91.5%), calcium to 321 (74%), and physical exercise to 421 (97%). CONCLUSIONS Patients referred to an FLS were younger, with a better functional and cognitive situation. At hospital discharge, they frequently presented gait impairment and laboratory abnormalities (anemia, hypoproteinemia, vitamin D deficiency) that presented good recovery due to the patient's previous baseline. These patients benefit from comprehensive treatment (pharmacological and non-pharmacological).
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Affiliation(s)
- Debora Moral-Cuesta
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain.
| | - Alicia Gutiérrez-Misis
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - Bernardo Abel Cedeño Veloz
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain; Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | | | - Itxaso Marin Epelde
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain
| | - Teresa Alarcón Alarcón
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain; Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Díez-Sebastián
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Sección de Epidemiología Clínica del Servicio de Medicina Preventiva, Madrid, Spain
| | - Arkaitz Galbete
- Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | | | - Nicolás Martínez Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain; Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | - Juan Ignacio González-Montalvo
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain; Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain
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[Post acute care of fragililty fractures]. MMW Fortschr Med 2021; 163:52-60. [PMID: 34533730 DOI: 10.1007/s15006-021-0221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zhao H, Tang Y, Zheng C, Ren L, Song G. Vitamin D Status is Independently Associated with Insulin Resistance in Patients with Type 2 Diabetes Mellitus. Risk Manag Healthc Policy 2021; 14:1393-1399. [PMID: 33854388 PMCID: PMC8039193 DOI: 10.2147/rmhp.s299963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose This study aimed to examine whether 25-hydroxyvitamin D (25OHD) levels (an indicator of vitamin D status) are independently associated with insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM). Patients and Methods This was a cross-sectional study. Participants with T2DM were recruited from the Department of Endocrinology in Hebei General Hospital according to inclusion and exclusion criteria. Data on basic characteristics and blood parameters were collected. We used the IR index (20/[fasting C-peptide × fasting plasma glucose]) to evaluate IR. Potential confounding factors were selected from comparisons among different IR index groups of quartiles and were adjusted in different models. Results We included 172 subjects (121 men and 51 women) whose mean age was 53.2±10.6 years. Body mass index (BMI), DM course, insulin use, glycated hemoglobin (HbA1c), fasting blood glucose, fasting C-peptide, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (ApoA1), and albumin were differed among different IR-index groups (all P value <0.05). In models 1 and 2, no or some confounding factors were adjusted for, and we found that there was no relationship between 25OHD and the IR index. In model 3, when all confounding factors (DM course, insulin use, BMI, HbA1c, TG, HDL-C, ApoA1, albumin and other bone turnover markers) were adjusted for, the IR index was increased by 5.6% when 25OHD levels increased by 1 ng/mL (odds ratio: 1.056; 95% confidence interval: 1.009, 1.105). Conclusion Vitamin D is independently associated with IR in patients with T2DM.
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Affiliation(s)
- Hang Zhao
- Endocrinology Department, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yong Tang
- Endocrinology Department, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Chong Zheng
- Pediatric Orthopaedics, Shijiazhuang the Third Hospital, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Luping Ren
- Endocrinology Department, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Guangyao Song
- Endocrinology Department, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People's Republic of China
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