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Zubick P, Dahlke S. Family/caregiver influence on osteoporosis management for older people: an integrative review. Osteoporos Int 2024; 35:1153-1163. [PMID: 38622263 DOI: 10.1007/s00198-024-07081-w] [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: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
An integrative literature review was conducted to understand family/caregiver influence on osteoporosis management for older people. Findings include caregivers' overprotection, caregivers' risks for fragility fractures due to caregiving role, poor bone health in caregivers, and caregivers' burden and facilitators. Caregivers should be included in bone health and discharge planning. Literature on family/caregiver influence on osteoporosis management for older people is sparse. Older people are prone to osteoporosis and fragility fractures due to their age, often triggering the need for a caregiver after experiencing a fragility fracture. These fractures pose significant costs to the patient and health systems and are projected to increase with the aging population. This study applied an integrative literature review methodology to key literature findings on family/caregiver influence on osteoporosis management for older people. Key findings include caregivers' tendency to overprotect persons who experience hip fracture by limiting mobilization, thus impeding recovery, caregivers' risks for their own fragility fractures due to the demands of their caregiving role, risks of poor bone health in caregivers, and caregivers' experience of significant burden for which facilitators have been identified. Family caregivers of older people with osteoporosis have unique needs and require support and resources, especially after their loved one experiences a hip fracture. Informal caregivers must be considered in bone health education and discharge planning. They should be considered in the creation of osteoporosis guidelines and within the work of fracture liaison services. More research is needed to increase understanding about family caregiver influence on osteoporosis management.
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Affiliation(s)
- Paula Zubick
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada.
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Jackson LE, Skains RM, Mudano A, Techarukpong N, Booth JS, Saag KG, Fraenkel L, Danila MI. An Emergency Department-based system intervention to improve osteoporosis screening for older adults at high-risk of fracture. JBMR Plus 2024; 8:ziae038. [PMID: 38681999 PMCID: PMC11055962 DOI: 10.1093/jbmrpl/ziae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 05/01/2024] Open
Abstract
Falls and osteoporosis are risk factors for fragility fractures. Bone mineral density (BMD) assessment is associated with better preventative osteoporosis care, but it is underutilized by those at high fracture risk. We created a novel electronic medical record (EMR) alert-driven protocol to screen patients in the Emergency Department (ED) for fracture risk and tested its feasibility and effectiveness in generating and completing referrals for outpatient BMD testing after discharge. The EMR alert was configured in 2 tertiary-care EDs and triggered by the term "fall" in the chief complaint, age (≥65 years for women, ≥70 years for men), and high fall risk (Morse score ≥ 45). The alert electronically notified ED study staff of potentially eligible patients. Participants received osteoporosis screening education and had BMD testing ordered. From November 15, 2020 to December 4, 2021, there were 2,608 EMR alerts among 2,509 patients. We identified 558 patients at high-risk of fracture who were screened for BMD testing referral. Participants were excluded for: serious illness (N = 141), no documented health insurance to cover BMD testing (N = 97), prior BMD testing/recent osteoporosis care (N = 58), research assistant unavailable to enroll (N = 53), concomitant fracture (N = 43), bedridden status (N = 38), chief complaint of fall documented in error (N = 38), long-term care residence (N = 34), participation refusal (N = 32), or hospitalization (N = 3). Of the 16 participants who had BMD testing ordered, 7 scheduled and 5 completed BMD testing. EMR alerts can help identify subpopulations who may benefit from osteoporosis screening, but there are significant barriers to identifying eligible and willing patients for screening in the ED. In our study targeting an innovative venue for osteoporosis care delivery, only about 1% of patients at high-risk of fracture scheduled BMD testing after an ED visit. Adequate resources during and after an ED visit are needed to ensure that older adults participate in preventative osteoporosis care.
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Affiliation(s)
- Lesley E Jackson
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Rachel M Skains
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
- Geriatrics Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, AL 35233, United States
| | - Amy Mudano
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Norma Techarukpong
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - James S Booth
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Liana Fraenkel
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, CT 06510, United States
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
- Geriatrics Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, AL 35233, United States
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Castañeda S, Navarro Ceballos C, Usón Jaeger J, de Miguel Benadiba C, Gómez Martín E, Martínez Díaz-Guerra G, Alvarez-Galovich L. Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts. Geriatrics (Basel) 2024; 9:24. [PMID: 38525741 PMCID: PMC10961758 DOI: 10.3390/geriatrics9020024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/15/2024] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Vertebral fragility fractures (VFF) pose a challenge for appropriate care. The aim of this study was to develop consensus recommendations for the management of VFF in older people from a multidisciplinary approach. Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was defined as 80% of responses of 8 (agree) and 9 (strongly agree) on a Likert scale. Consensus was achieved in 22 recommendations (62.8%). The experts agreed on the need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX®), did not achieve an agreed consensus. Also, there was consensus regarding the administration of calcium/vitamin D supplements, the withdrawal of toxic habits, and personalized physical exercise. Participants agreed on the administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. Although there was multidisciplinary agreement on diagnostic tests and non-pharmacological and pharmacological treatment in frail older people, therapeutic objectives should be individualized for every patient. In addition to the specific recommendations, close collaboration between the geriatrician and the primary care physician is essential for the optimal chronic management of frail patients with fragility fractures.
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Affiliation(s)
- Santos Castañeda
- Rheumatology Service, Hospital Universitario La Princesa, IIS-Princesa, 28006 Madrid, Spain
- Cátedra UAM-Roche, EPID-Future, Department of Medicine, Autonomous University of Madrid (UAM), 28049 Madrid, Spain
| | | | - Jaqueline Usón Jaeger
- Rheumatology Service, Hospital General Universitario de Móstoles, Móstoles, 28935 Madrid, Spain;
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Mitchell PJ, Chan DCD, Lee JK, Tabu I, Alpuerto BB. The global burden of fragility fractures - what are the differences, and where are the gaps. Best Pract Res Clin Rheumatol 2022; 36:101777. [PMID: 36089481 DOI: 10.1016/j.berh.2022.101777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current burden of fragility fractures is enormous, and it is set to increase rapidly in the coming decades as humankind enters a new demographic era. The purpose of this review is to consider, in different settings: • The human and economic toll of fragility fractures. • Risk factors for fragility fractures. • Current acute management of fragility fractures. • Current care gaps in both secondary and primary fracture prevention. A summary of global, regional, and national initiatives to improve the quality of care is provided, in addition to proposals for the research agenda. Systematic approaches to improve the acute care, rehabilitation and prevention of fragility fractures need to be developed and implemented rapidly and at scale in high-, middle- and low-income countries throughout the world. This must be an essential component of our response to the ageing of the global population during the remainder of the current United Nations - World Health Organization "Decade of Healthy Ageing".
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Affiliation(s)
- Paul James Mitchell
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Australia; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Synthesis Medical NZ Limited, Pukekohe, New Zealand.
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Changde St, Taipei, 100, Taiwan.
| | - Joon-Kiong Lee
- Beacon Hospital, 1, Jalan 215, Section 51, Off Jalan Templer, 46050, Petaling Jaya, Selangor, Malaysia.
| | - Irewin Tabu
- Department of Orthopaedics, University of the Philippines - Philippine General Hospital, Manila, Philippines; Institute on Aging-National Institutes of Health, UP Manila, Philippines.
| | - Bernardino B Alpuerto
- Department of Orthopaedics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
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