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Seward MW, Hannon CP, Yuan BJ, Kearns AE, Anderson PA, Berry DJ, Abdel MP. Systemic Osteoporosis and Osteopenia Among Periprosthetic Fractures After Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00577-1. [PMID: 38852691 DOI: 10.1016/j.arth.2024.06.002] [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: 02/26/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Most periprosthetic fractures following total hip arthroplasty (THA) are fragility fractures that qualify patients for osteoporosis diagnoses. However, it remains unknown how many patients were diagnosed who had osteoporosis before injury or received the proper evaluation, diagnosis, and treatment after injury. METHODS We identified 171 Vancouver B2 (109) and B3 (62) periprosthetic femur fractures treated with a modular fluted tapered stem from 2000 to 2018 at 1 institution. The mean patient age was 75 years (range, 35 to 94), 50% were women, and the mean body mass index was 29 (range, 17 to 60). We identified patients who had osteoporosis or osteopenia diagnoses, a fracture risk assessment tool (FRAX), bone mineral density (BMD) testing, an endocrinology consult, and osteoporosis medications. Age-appropriate BMD testing was defined as no later than 1 year after the recommended ages of 65 (women) or 70 years (men). The mean follow-up was 11 years (range, 4 to 21). RESULTS Falls from standing height caused 94% of fractures and thus, by definition, qualified as osteoporosis-defining events. The prevalence of osteoporosis diagnosis increased from 20% before periprosthetic fracture to 39% after (P < .001). The prevalence of osteopenia diagnosis increased from 13% before the fracture to 24% after (P < .001). The prevalence of either diagnosis increased from 24% before fracture to 44% after (P < .001). No patients had documented FRAX scores before fracture, and only 2% had scores after. The prevalence of BMD testing was 21% before fracture and 22% after (P = .88). By the end of the final follow-up, only 16% had received age-appropriate BMD testing. The proportion of patients who had endocrinology consults increased from 6% before the fracture to 25% after (P < .001). The proportion on bisphosphonate therapy was 19% before fracture and 25% after (P = .08). CONCLUSIONS Although most periprosthetic fractures following THA are fragility fractures that qualify patients for osteoporosis diagnoses, there remain major gaps in diagnosis, screening, endocrinology follow-up, and treatment. Like nonarthroplasty fragility fractures, a systematic approach is needed after periprosthetic fractures. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Michael W Seward
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Charles P Hannon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brandon J Yuan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ann E Kearns
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Paul A Anderson
- Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Chapman PN, Georgiadis GM, Seegert S, Russell B, O'Mara-Gardner K, Bair JM, Tank JC. Outcomes and Risks Associated With Subsequent Contralateral Hip Fractures. Orthopedics 2024:1-6. [PMID: 38810129 DOI: 10.3928/01477447-20240520-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Hip fractures constitute a major public health problem for older individuals. They are associated with functional deterioration, limited mobility, and increased mortality, while contributing to economic and social hardships that are compounded by a second hip fracture. With the aging US population and increasing rates of hip fractures, it is essential to understand factors surrounding subsequent contralateral hip fractures. MATERIALS AND METHODS This descriptive study was a retrospective review of patients 60 years and older who were identified in the institutional geriatric hip fracture database as having had an initial and subsequent contra-lateral hip fracture, with the second treated at our tertiary referral center. RESULTS The incidence of subsequent hip fracture was 13.2%. The mean time to second hip fracture was 3.5 years after the initial injury. The first fracture tended to be a femoral neck fracture, whereas the second injury was more likely to have an intertrochanteric pattern. There was a higher complication rate after a subsequent hip fracture. Patients taking osteoporosis and adjuvant medication prior to admission for the second fracture tended to have a lower 90-day mortality rate. Patients with a history of any fracture prior to the first hip fracture, with cancer, and with osteopenia had shorter intervals to the subsequent event. CONCLUSION Subsequent hip fractures carry high morbidity and mortality rates. Steps should be taken after the initial injury to optimize outcomes in the case of a subsequent event. Patients discharged after initial hip fracture should be maintained with osteoporosis medication. [Orthopedics. 202x;4x(x):xx-xx.].
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Hou X, Zhang N, Guo L, Wang Y, Zheng M, Chen S, Liu P, Wang M, Li J, Wu S, Tian F. Cumulative exposure to remnant cholesterol and the risk of fragility fractures: a longitudinal cohort study. Front Endocrinol (Lausanne) 2023; 14:1251344. [PMID: 38089619 PMCID: PMC10713996 DOI: 10.3389/fendo.2023.1251344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Objective To investigate the association between cumulative remnant cholesterol (cumRC) and the risk of new-onset fragility fractures. Methods This study included individuals who participated in the 2006, 2008, and 2010 Kailuan health examinations. Baseline characteristics were compared between groups according to cumRC quartiles. The incidence density was calculated, and the log-rank test was used to compare the cumulative incidence. Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI), and restricted cubic spline was used to examine the possibly non-linear relation between cumRC and the risk of fragility fractures. Additional analyses were performed with stratification by age (≥ or <65 years). Results A total of 43,839 individuals were included in this study. During the median follow-up period of 10.97 years, a total of 489 fragility fractures occurred. Multivariable Cox proportional hazards regression model 3 showed that the Q1 and Q4 groups versus the Q2 group were associated with a higher HR of fragility fracture (HR 1.61, 95% CI: 1.23-2.11; HR 1.38, 95% CI: 1.06-1.81), and restricted cubic spline regression analysis showed a non-linear relationship between cumRC level and the risk of fragility fractures (P Overall association < 0.001, P Non-linear association = 0.001). The association was significant in the age group <65 years but not in the age group ≥65 years. The sensitivity analyses were consistent with the main results. Conclusions Both too high and too low cumRC levels were associated with a greater risk of fragility fractures, and this association was more significant in young and middle-aged people.
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Affiliation(s)
- Xiaoli Hou
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Nan Zhang
- Orthopedics Department, Kailuan General Hospital, Tangshan, China
| | - Lu Guo
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yongheng Wang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Mengyi Zheng
- Cardiology Department, Capital Medical University, Beijing, China
| | - Shuohua Chen
- Cardiology Department, Kailuan General Hospital, Tangshan, China
| | - Peipei Liu
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Mengqin Wang
- Emergency Department, Jishuitan, The Fourth Clinical Hospital of Peking University, Beijing, China
| | - Jia Li
- Jitang College, North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Cardiology Department, Kailuan General Hospital, Tangshan, China
| | - Faming Tian
- School of Public Health, North China University of Science and Technology, Tangshan, China
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Tabu I, Goh EL, Appelbe D, Parsons N, Lekamwasam S, Lee JK, Amphansap T, Pandey D, Costa M. Service availability and readiness for hip fracture care in low- and middle-income countries in South and Southeast Asia. Bone Jt Open 2023; 4:676-681. [PMID: 37666496 PMCID: PMC10477024 DOI: 10.1302/2633-1462.49.bjo-2023-0075.r1] [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] [Indexed: 09/06/2023] Open
Abstract
Aims The aim of this study was to describe the current pathways of care for patients with a fracture of the hip in five low- and middle-income countries (LMIC) in South Asia (Nepal and Sri Lanka) and Southeast Asia (Malaysia, Thailand, and the Philippines). Methods The World Health Organization Service Availability and Readiness Assessment tool was used to collect data on the care of hip fractures in Malaysia, Thailand, the Philippines, Sri Lanka, and Nepal. Respondents were asked to provide details about the current pathway of care for patients with hip fracture, including pre-hospital transport, time to admission, time to surgery, and time to weightbearing, along with healthcare professionals involved at different stages of care, information on discharge, and patient follow-up. Results Responses were received from 98 representative hospitals across the five countries. Most hospitals were publicly funded. There was consistency in clinical pathways of care within country, but considerable variation between countries. Patients mostly travel to hospital via ambulance (both publicly- and privately-funded) or private transport, with only half arriving at hospital within 12 hours of their injury. Access to surgery was variable and time to surgery ranged between one day and more than five days. The majority of hospitals mobilized patients on the first or second day after surgery, but there was notable variation in postoperative weightbearing protocols. Senior medical input was variable and specialist orthogeriatric expertise was unavailable in most hospitals. Conclusion This study provides the first step in mapping care pathways for patients with hip fracture in LMIC in South Asia. The previous lack of data in these countries hampers efforts to identify quality standards (key performance indicators) that are relevant to each different healthcare system.
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Affiliation(s)
- Irewin Tabu
- Department of Orthopedics, University of the Philippines Manila, Manila, Philippines
- Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - En L. Goh
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Duncan Appelbe
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Sarath Lekamwasam
- University of Ruhuna, Matara, Sri Lanka
- Department of Medicine, University of Ruhuna, Matara, Sri Lanka
| | | | | | | | - Matthew Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - On behalf of FERMAT collaborators and the Global Fragility Fracture Network Hip Fracture Audit Special Interest Group
- Department of Orthopedics, University of the Philippines Manila, Manila, Philippines
- Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- University of Warwick Faculty of Medicine, Coventry, UK
- University of Ruhuna, Matara, Sri Lanka
- Department of Medicine, University of Ruhuna, Matara, Sri Lanka
- Beacon Hospital, Petaling Jaya, Malaysia
- Police General Hospital, Bangkok, Thailand
- National Trauma Center, Kathmandu, Nepal
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Arboleya L, Cancio-Trujillo JM, Chaves C, Duaso-Magaña E, Mesa-Ramos M, Olmos JM. A Delphi consensus on the management of Spanish patients with osteoporosis at high risk of fracture: OSARIDELPHI study. Arch Osteoporos 2023; 18:110. [PMID: 37610481 PMCID: PMC10447260 DOI: 10.1007/s11657-023-01318-7] [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: 02/10/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
The OSARIDELPHI study evaluated the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. The results provide expert-based recommendations for prevention, diagnosis, and treatment related to fracture risk. Therefore, the study facilitates clinical decision-making for managing this patient's profile. PURPOSE To evaluate the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. METHODS A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with assessments on a 9-point Likert scale. Item selection was based on acceptance by ≥ 66.6% of panel experts and the agreement of the scientific committee. In round 2, the same panelists evaluated non-consensus items in round 1. RESULTS A total of 80 panelists participated in round 1; of these, 78 completed the round 2 survey. In round 1, 122 items from 4 dimensions (definition of fracture risk: 11 items, prevention and diagnosis: 38 items, choice of treatment: 24 items, and treatment-associated quality of life: 49 items) were evaluated. The consensus was reached for 90 items (73.8%). Panelists agreed that categorizing high risk, very high risk, or imminent risk determines secondary prevention actions (97.5%). Experts agreed that treatment with bone-forming drugs should be considered in case of a very high risk of fracture, and a sequential change to antiresorptive drugs should be made after 1-2 years (97.5%). Panelists also recommended corrective action plans for non-adherent patients to improve adherence (97.5%). A total of 131 items were finally accepted after round 2. CONCLUSION This Delphi study provides expert-based recommendations on clinical decision-making for managing patients with osteoporosis at high risk of fracture.
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Affiliation(s)
- Luis Arboleya
- Rheumatology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | | | - Celia Chaves
- Medical Affairs Department, STADA, Barcelona, Spain
| | - Enric Duaso-Magaña
- Acute Geriatric Unit, Geriatric Service, Hospital de Igualada, Barcelona, Spain
| | - Manuel Mesa-Ramos
- Orthopedic Service. Hospital Valle de los Pedroches, Pozoblanco, Córdoba, Spain
| | - Jose Manuel Olmos
- Internal Medicine Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
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Lai H, Fan J, Liu H, Wu X, Wang L, Gao L, Zhou L, Chen T, Zhang L, Chen J, Luo Z. Fracture liaison services combined with online home nursing care in fragility hip fracture: a comparative effectiveness pilot study. Arch Osteoporos 2023; 18:33. [PMID: 36809579 DOI: 10.1007/s11657-023-01221-1] [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: 10/10/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
Fracture liaison service (FLS) is a management system for osteoporotic fractures, its difficulty lies in long-term management. Through this pilot single-center study, we found that FLS combined with an internet-based follow-up service (online home nursing care) can economically and conveniently monitor patients, reduce falls and refractures, and improve care and medication adherence. INTRODUCTION Among potential e-health platforms, mobile internet encompasses the largest user group of mobile instant messaging software in Asia and offers strong interaction, low cost, and fast speed. The online home nursing care model prevents unnecessary hospital admissions and readmissions. This study aims to explore the effects of a fracture liaison service (FLS) model combined with online home nursing care on patients with fragility hip fracture. METHODS Patients discharged after November 2020 received FLS care combined with online home nursing care. Patients discharged from May 2020 to November 2020 received only routine discharge guidance and were classified as the control group. The Parker Mobility Score (PMS), Medical Outcomes Study 36-item short-form health survey (MOS SF-36), general medication adherence scale (GMAS), complication rate, and fall/refracture rates were used to evaluate the efficacy of the FLS combined with online home nursing care during the 52-week follow-up period. RESULTS Eighty-nine patients with complete follow-up information were included in the analysis at the 52-week follow-up. The FLS combined with online home nursing care was associated with improved osteoporosis patient care, including increased medication adherence (64.58% in the control group and 90.24% in the observation group), improved mental quality of life, reduced fall/refracture rate (12.5% and 4.88%, respectively), and reduced rates of bedsores and joint stiffness; however, there was no effect on functional recovery within 1 year. CONCLUSIONS We recommend the combination of FLS with online home nursing care, considering the local environment, to economically and conveniently monitor patients, reduce falls and refractures, and improve care and medication adherence.
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Affiliation(s)
- Hehuan Lai
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Jialin Fan
- Lishui Second People's Hospital, Beihuan Road 69, Liandu District, Lishui, 323000, Zhejiang Province, China
| | - Huan Liu
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Xiufen Wu
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Lingming Wang
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Liumei Gao
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Lili Zhou
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Tingting Chen
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Le Zhang
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Jing Chen
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China
| | - Zhiping Luo
- Department of Orthopedic Surgery, Affiliated Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, Zhejiang Province, China.
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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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Improving referrals to a fracture liaison service: Screening for osteoporosis. Int J Orthop Trauma Nurs 2022; 47:100964. [PMID: 36423534 DOI: 10.1016/j.ijotn.2022.100964] [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: 04/11/2022] [Revised: 07/07/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022]
Abstract
With the elderly population living longer and 'baby boomer's now reaching the age of 65, there is great concern regarding a lack of diagnosis and treatment of osteoporosis. Osteoporosis is a well-known problem, yet there continue to be gaps regarding screening and treatment. An orthopaedic practice in the Southeastern United States specializing in bone health has an internal Fracture Liaison Service (FLS) that was not being fully utilized by the providers. A quality improvement project was implemented following the recommended FLS guidelines to identify individuals that should receive referral to the FLS. Chart audits were completed to analyze both pre- and post-implementation phases. An alert button was introduced into the electronic health record to prompt orthopaedic surgeons to refer to the FLS clinic when individuals met the requirements of age and a first-time fragility fracture. Descriptive data showed 5% FLS referrals in 2019. After implementation of the alert button the FLS referrals for 2020 were 19%, providing a 14% overall improvement rate. Evidence supports using standardized screening processes and that referring to an FLS is best practice for improving the treatment of osteoporosis and for decreasing morbidity, mortality, and health care cost.
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The Effectiveness of Fracture Liaison Services in Improving Fragility Fracture Outcomes. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2022. [DOI: 10.1007/s40674-021-00190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Abstract
Osteoporosis is a skeletal disease characterized by low bone density and poor bone quality that weakens bones and increases the risk of fractures. Serious consequences of fractures include disability, loss of independence, and death. Despite the availability of clinical tools to evaluate fracture risk and medications to reduce fracture risk, many or most patients at risk, even those with a recent fracture, are not being treated. This represents a large osteoporosis treatment gap that has reached a crisis level. Importantly, the treatment gap is not evenly distributed among populations of different race/ethnicity. Black women are less likely to have bone density testing when indicated, are less likely to be treated, and have worse outcomes after a fracture than White women. This is a review and update of race-based disparities and inequalities, with suggestions for interventions to optimize patient care.
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Affiliation(s)
- E Michael Lewiecki
- E. Michael Lewiecki, MD, New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM
- Sarah F. Erb, FNP-C, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Sarah F Erb
- E. Michael Lewiecki, MD, New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM
- Sarah F. Erb, FNP-C, University of New Mexico Health Sciences Center, Albuquerque, NM
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Wong RMY, Ko SY, Chau WW, Lee LCY, Chow SKH, Cheung WH, Law SW. The first reported fracture liaison service (FLS) for vertebral fractures in China: is muscle the missing gap? Arch Osteoporos 2021; 16:168. [PMID: 34743234 DOI: 10.1007/s11657-021-01036-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fracture liaison services (FLS) have been implemented worldwide, but we present one of the first reported experiences in China. Only 1 out of 226 patients had a secondary fracture within 1 year. This serves as a platform to improving solutions and decreasing imminent fractures for future use nationwide in China. INTRODUCTION Fracture liaison services (FLS) have been implemented worldwide but we present one of the first reported experiences in China. Vertebral fragility fracture is one of the earliest fracture to occur. The objective of this study was to implement a dedicated fracture service to decrease imminent fractures for future use nationwide in China. METHODS Patients 50 years or older with a recent vertebral compression fracture were recruited. All patients were offered investigation with DXA scan and blood taking. Treatment was provided with calcium and vitamin D supplements and denosumab injections. The primary outcome was the imminent fracture rate or the re-fracture rate occurring within 2 years of the initial one. Secondary outcomes were bone mineral density (BMD), treatment initiation, adherence to drug, compliance to follow-up, falls, mortality, pain, quality of life, pain-related disability with Roland-Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). RESULTS Two hundred twenty-six patients (n = 226) were analyzed. 0.4% (n = 1) had an imminent fracture within 2 years. 11.1% (n = 25) had a fall within 2 years, in which 1 resulted in a major osteoporotic fracture. 7.1% died (n = 16) within the 2-year time period. 97.8% (n = 221) underwent BMD investigation with an initial DXA scan. One hundred percent (n = 226) had treatment initiation and were prescribed with Denosumab injections. 89.8% (n = 203) were compliant and showed complete adherence to drug therapy over the 2 years. Pain, quality of life, and disability were significantly improved. CONCLUSION This is the first reported fracture liaison service for vertebral fracture patients reported in China. Future FLS should incorporate muscle and sarcopenic assessments as a routine, and also research on novel interventions in this area would significantly improve patient outcomes.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Shaau Yiu Ko
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai-Wang Chau
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Linus Chee Yeen Lee
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon Kwoon Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
| | - Sheung Wai Law
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
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Minimizing Nonessential Follow-up for Hip Fracture Patients. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202106000-00002. [PMID: 34077401 PMCID: PMC8174547 DOI: 10.5435/jaaosglobal-d-21-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
Abstract
Hip fractures pose a significant burden to patients and care providers. The
optimal protocol for postoperative care across all surgically treated hip
fracture patients is unknown. The purpose of this study was to investigate the
effect that routine follow-up had on changing the clinical course.
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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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Experience gained from the implementation of the fracture liaison service in Greece. Arch Osteoporos 2020; 15:12. [PMID: 31897772 DOI: 10.1007/s11657-019-0675-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION We present the second implementation of a fracture liaison service (FLS) at a national level in Greece. METHODS This was a multicenter prospective study, organized by the Hellenic Society for the Study of Bone Metabolism, aiming to investigate the tracking and outcome of patients with low-trauma fractures visiting four university orthopedic departments across the country. The primary endpoint was the participation rate of eligible patients with low-trauma fractures in the program within a time frame of 1 year. Secondary outcomes included the percentage of patients initiating osteoporosis treatment, adherence to treatment, and the percentage of patients experiencing subsequent fractures. A major difference with previous reports was the designed implication of the orthopedic surgeon managing the fracture. RESULTS Among the 1350 eligible patients with major osteoporotic fractures, only 396 (29.3%; mean age 78.1 ± 11.6 years; female/male ratio: 4.4) agreed to participate, nearly all of the latter (n = 392) completing the study. With the exception of seven patients, all participants were receiving anti-osteoporotic treatment at the end of the study. Twelve new fractures were recorded at completion of the 12-month follow-up, which were all sustained in patients who either declined to receive anti-osteoporotic treatment or who discontinued treatment despite advice to the contrary. CONCLUSION The participation rate remains low and needs improvement. However, we report herein that whenever the treating physician is involved in the FLS structure, patients are more easily convinced to complete the program, to receive anti-osteoporotic treatment, and to stay connected throughout with the outpatient clinic.
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Suhm N, Egger A, Zech C, Eckhardt H, Morgenstern M, Gratza S. Low acceptance of osteoanabolic therapy with parathyroid hormone in patients with fragility fracture of the pelvis in routine clinical practice: a retrospective observational cohort study. Arch Orthop Trauma Surg 2020; 140:321-329. [PMID: 31332508 PMCID: PMC7033084 DOI: 10.1007/s00402-019-03241-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A recent randomized controlled trial has reported full patient compliance and no adverse events from therapy with parathyroid hormone (PTH) for osteoporosis and accelerated healing of fragility fractures of the pelvis. The purpose of the presented study was to evaluate if similar results can be achieved with comprehensive PTH therapy in routine clinical practice. We hypothesised that patients' burden of PTH therapy is underestimated in the literature. PATIENTS AND METHODS Osteoanabolic PTH therapy was recommended to 79 patients suffering from an acute fragility fracture of the pelvis (FFP). Case finding, initiation of therapy and follow-up were performed by a fracture liaison service team. Primary outcome was PTH initiation rate. Secondary outcomes were implementation rate of alternative antiresorptive pharmaceutical therapy for osteoporosis and participation rate in a bone metabolic workup. Adverse events and effects potentially related to the therapy with bone-active drugs were documented as exploratory outcomes. RESULTS Osteoanabolic PTH therapy as suggested was accepted by 32%, whereas antiresorptive therapy was implemented in another 14% of the patients. DEXA scans were available in 38% of the patients (+ 27% when compared to baseline). A bone-specific laboratory analysis was done in 18 patients, uncovering 7 pathological findings. Two patients terminated PTH therapy early because of side effects. CONCLUSION The experiences with PTH therapy in FFP patients with respect to, implementation rate, frequency of side effects and of pathological findings in laboratory controls as reported from a previous RCT could not be reproduced in routine clinical practice.
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Affiliation(s)
- Norbert Suhm
- grid.410567.1Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Alexander Egger
- grid.410567.1Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Christoph Zech
- grid.410567.1Department of Interventional Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Henrik Eckhardt
- grid.410567.1Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Mario Morgenstern
- grid.410567.1Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Simon Gratza
- grid.410567.1Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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Leonhardt Y, May P, Gordijenko O, Koeppen-Ursic VA, Brandhorst H, Zimmer C, Makowski MR, Baum T, Kirschke JS, Gersing AS, Seifert-Klauss V, Schwaiger BJ. Opportunistic QCT Bone Mineral Density Measurements Predicting Osteoporotic Fractures: A Use Case in a Prospective Clinical Cohort. Front Endocrinol (Lausanne) 2020; 11:586352. [PMID: 33240220 PMCID: PMC7680958 DOI: 10.3389/fendo.2020.586352] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/14/2020] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess whether volumetric vertebral bone mineral density (BMD) measured with opportunistic quantitative computed tomography (QCT) (i.e., CT acquired for other reasons) can predict osteoporotic fracture occurrence in a prospective clinical cohort and how this performs in comparison to dual-energy X-ray absorptiometry (DXA) measurements. METHODS In the database of our fracture liaison service, 58 patients (73 ± 11 years, 72% women) were identified that had at least one prevalent low-energy fracture and had undergone CT of the spine. BMD was determined by converting HU using scanner-specific conversion equations. Baseline DXA was available for 31 patients. During a 3-year follow-up, new fractures were diagnosed either by (i) recent in-house imaging or (ii) clinical follow-up with validated external reports. Associations were assessed using logistic regression models, and cut-off values were determined with ROC/Youden analyses. RESULTS Within 3 years, 20 of 58 patients presented new low-energy fractures (34%). Mean QCT BMD of patients with fractures was significantly lower (56 ± 20 vs. 91 ± 38 mg/cm3; p = 0.003) and age was higher (77 ± 10 vs. 71 ± 11 years; p = 0.037). QCT BMD was significantly associated with the occurrence of new fractures, and the OR for developing a new fracture during follow-up was 1.034 (95% CI, 1.010-1.058, p = 0.005), suggesting 3% higher odds for every unit of BMD decrease (1 mg/cm3). Age and sex showed no association. For the differentiation between patients with and without new fractures, ROC showed an AUC of 0.76 and a Youden's Index of J = 0.48, suggesting an optimal cut-off value of 82 mg/cm3. DXA T-scores showed no significant association with fracture occurrence in analogous regression models. CONCLUSION In this use case, opportunistic BMD measurements attained through QCT predicted fractures during a 3-year follow-up. This suggests that opportunistic measurements are useful to reduce the diagnostic gap and evaluate the fracture risk in osteoporotic patients.
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Affiliation(s)
- Yannik Leonhardt
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
- *Correspondence: Yannik Leonhardt,
| | - Pauline May
- Interdisciplinary Osteoporosis Center, Department of Gynaecology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Olga Gordijenko
- Department of Trauma Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Veronika A. Koeppen-Ursic
- Department of Orthopedics and Trauma Surgery, Klinikum Freising, Technical University of Munich, Freising, Germany
| | - Henrike Brandhorst
- Interdisciplinary Osteoporosis Center, Department of Gynaecology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R. Makowski
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S. Gersing
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Vanadin Seifert-Klauss
- Interdisciplinary Osteoporosis Center, Department of Gynaecology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J. Schwaiger
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
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Pennestrì F, Corbetta S, Favero V, Banfi G. Fragility Fracture Prevention-Implementing a Fracture Liaison Service in a High Volume Orthopedic Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244902. [PMID: 31817294 PMCID: PMC6950760 DOI: 10.3390/ijerph16244902] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 11/16/2022]
Abstract
Fragility fractures pose a serious threat to patient health, quality of life, and healthcare sustainability. In order to reduce their clinical, social, and economic burden, a Fracture Liaison Service (FLS) was introduced in a high volume orthopedic hospital in 2017. The purpose of this retrospective observational study is to describe the FLS protocol, introduce its preliminary outcomes, and provide an early evaluation in light of international guidelines and recommendations. All the performances suggested by the International Osteoporosis Foundation (IOF) are provided under the same institution by which a patient is admitted for surgery. Clinical indicators from patient history and administrative indicators from the hospital database have been used to estimate the spread of fragility fracture prevention and the degree of patient compliance to these programs. The research included 403 patients. Although, almost 1/3 were admitted for the second fragility fracture, only half received anti-osteoporotic treatment before it. The degree of prevention was even lower in the case of patients admitted for the first fragility fracture. The risk of being affected by a secondary fracture was seven times higher when patients did not attend any follow-up or diagnostic exam. In order to identify the main determinants of compliance with FLS and perform a cost-effectiveness analysis on a larger sample, it is fundamental to integrate data from different providers.
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Affiliation(s)
- Federico Pennestrì
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20161 Milan, Italy;
- Correspondence: ; Tel.: +39-02-66214850
| | - Sabrina Corbetta
- IRCCS Orthopedic Institute Galeazzi, Endocrinology and Diabetology Service, 20161 Milan, Italy; (S.C.); (V.F.)
- Department of Biomedical, Surgical and Odontoiatric Services, University of Milan, 20122 Milan, Italy
| | - Vittoria Favero
- IRCCS Orthopedic Institute Galeazzi, Endocrinology and Diabetology Service, 20161 Milan, Italy; (S.C.); (V.F.)
- Department of Biomedical, Surgical and Odontoiatric Services, University of Milan, 20122 Milan, Italy
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20161 Milan, Italy;
- Università Vita-Salute San Raffaele, Scientific Direction, 20132 Milan, Italy
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Yoo JI, Ha YC, Park KS, Kim RB, Seo SH, Koo KH. Incidence and Mortality of Osteoporotic Refractures in Korea according to Nationwide Claims Data. Yonsei Med J 2019; 60:969-975. [PMID: 31538432 PMCID: PMC6753341 DOI: 10.3349/ymj.2019.60.10.969] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/16/2019] [Accepted: 08/09/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Studies on the incidence and mortality of refractures after primary osteoporotic fracture are limited by the relatively rare incidence of such refractures and small sample sizes. The objectives of this research were: 1) to determine the incidence of osteoporotic refractures and fracture locations and 2) to assess mortality rates associated with osteoporotic refracture over a median follow up of 3 years using nationwide claim database. MATERIALS AND METHODS Patients over 50 years of age who had an osteoporotic fracture that was confirmed operationally were enrolled. Refracture was defined as that after 6 months of an untreated period. Mortality rate was calculated using the Charlson comorbidity index and was analyzed using Cox proportional hazards regression analysis. RESULTS A total of 18956 first-time instances of osteoporotic fracture were reported between 2007 and 2012 after a median follow up of 3.1 years (range, 1 to 7 years). Among 18956 patients, 2941 (15.50%) experienced refracture. After follow up for 1 year, cumulative mortality rates for re-fracture and non-refracture groups were 9.1% and 7.2%, respectively. After adjusting for covriates, mortality rate was 1.2 times greater in patients with re-fracture than in patients without re-fracture over a median follow up of 3 years (hazard ratio: 1.20, 95% confidence interval: 1.08-1.34, p<0.001). CONCLUSION The incidence of osteoporotic re-fracture in this nationwide study was 15.5%, and the mortality rate of re-fracture patients was 1.2 times higher than that of non-refracture patients over a median follow up of 3 years.
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Affiliation(s)
- Jun Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Ki Soo Park
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Rock Beum Kim
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Sung Hyo Seo
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Kyung Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Noordin S, Masri B. Editorial. Int J Surg 2018; 54:315. [DOI: 10.1016/j.ijsu.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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