1
|
McCloskey E, Tan ATH, Schini M. Update on fracture risk assessment in osteoporosis. Curr Opin Endocrinol Diabetes Obes 2024; 31:141-148. [PMID: 38809256 DOI: 10.1097/med.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW The assessment of fracture risk is playing an ever-increasing role in osteoporosis clinical management and informing international guidelines for osteoporosis. FRAX, a fracture risk calculator that provides individualized 10-year probabilities of hip and major osteoporotic fracture, has been widely used since 2008. In this review, we recap the development and limitations of intervention thresholds and the role of absolute fracture risk. RECENT FINDINGS There is an increasing awareness of disparities and inequities in the setting of intervention thresholds in osteoporosis. The limitations of the simple use of prior fracture or the DXA-derived BMD T -score threshold are increasingly being discussed; one solution is to use fracture risk or probabilities in the setting of such thresholds. This approach also permits more objective assessment of high and very high fracture risk to enable physicians to make choices not just about the need to treat but what agents to use in individual patients. SUMMARY Like all clinical tools, FRAX has limitations that need to be considered, but the use of fracture risk in deciding who to treat, when to treat and what agent to use is a mechanism to target treatment equitably to those at an increased risk of fracture.
Collapse
Affiliation(s)
- Eugene McCloskey
- Division of Clinical Medicine, School of Medicine and Population Health
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Andre T H Tan
- Fast and Chronic Programmes, Alexandra Hospital, Queenstown
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Marian Schini
- Division of Clinical Medicine, School of Medicine and Population Health
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| |
Collapse
|
2
|
Janssens S, Gielen E, Laurent MR, Sermon A, Herteleer M, Dejaeger M. Hospitalizations for hip and non-hip osteoporotic fractures in Belgium: nationwide trends between 2010 and 2021. Arch Osteoporos 2024; 19:62. [PMID: 39034383 DOI: 10.1007/s11657-024-01423-1] [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: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
This study aimed to describe the incidence of hospitalizations for osteoporotic fractures in patients aged 50 years and over in Belgium between 2010 and 2021. A declining trend in crude and age-adjusted hospitalization incidence was observed, however, the absolute number of hospitalisations for osteoporotic fractures increased due to demographic changes. PURPOSE The secular trends of hospitalizations for hip and other osteoporotic fractures between 2010 and 2021 in patients aged 50 years and over in Belgium are unknown. This study aimed to describe the incidence of hospitalizations for osteoporotic fractures in patients aged 50 years and over in Belgium between 2010 and 2021. METHODS Population-based, retrospective study based on hospitalization data extracted by the national database NIHDI and demographical data retrieved from the Belgian Federal Bureau for Statistics. Data were combined to determine the crude and age-standardized hospitalization incidence of fractures of the hip, distal femur, pelvis, humerus, wrist, and spine (2010 as the reference year). RESULTS A total of 445,234 hospitalizations for osteoporotic fractures were reported between 2010 and 2021 (excluding 2015). Hospitalizations increased by 5.8% between 2010 and 2021 (p = 0.013) with a higher increase in men (12.1%; p = 0.001) compared to women (4.1%; p = 0.041). The crude incidence of hospitalizations for all fractures per 100,000 persons per year decreased from 990 to 910 between 2010 and 2021 (p = 0.572). The age-standardized incidence for hospitalizations of any osteoporotic fracture in men declined from 5.30/1,000 to 4.42/1,000 (p = 0.010). In women, a similar decrease was observed (13.84/1,000 to 11.62/1,000; p = 0.003). Both age-standardized hospitalizations for hip and non-hip fractures showed a decrease in both sexes. CONCLUSION Although a declining trend in the crude incidence per 100,000 and in the age-adjusted incidence of hospitalizations for osteoporotic fractures was observed, the absolute number of hospitalizations for osteoporotic fractures increased due to the demographic change of an ageing population.
Collapse
Affiliation(s)
- Sigrid Janssens
- Department of Public Health and Primary Care, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Evelien Gielen
- Department of Public Health and Primary Care, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium
| | - Michaël R Laurent
- Department of Geriatric Medicine, Imelda Hospital, Bonheiden, Belgium
| | - An Sermon
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
- Department of Traumatology, University Hospitals Leuven, Louvain, Belgium
| | - Michiel Herteleer
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
- Department of Traumatology, University Hospitals Leuven, Louvain, Belgium
| | - Marian Dejaeger
- Department of Public Health and Primary Care, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium.
| |
Collapse
|
3
|
Arcidiacono GP, Ceolin C, Sella S, Camozzi V, Bertocco A, Torres MO, Rodà MG, Cannito M, Berizzi A, Romanato G, Venturin A, Cianci V, Pizziol A, Pala E, Cerchiaro M, Savino S, Tessarin M, Simioni P, Sergi G, Ruggieri P, Giannini S. Taking care of inpatients with fragility hip fractures: the hip-padua osteosarcopenia (Hip-POS) fracture liaison service model. J Endocrinol Invest 2024:10.1007/s40618-024-02425-z. [PMID: 38971949 DOI: 10.1007/s40618-024-02425-z] [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: 04/03/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE Osteoporotic fragility fractures (FF), particularly those affecting the hip, represent a major clinical and socio-economic concern. These fractures can lead to various adverse outcomes, which may be exacerbated by the presence of sarcopenia, especially among older and frail patients. Early identification of patients with FF is crucial for implementing effective diagnostic and therapeutic strategies to prevent subsequent fractures and their associated consequences. METHODS The Hip-POS program, implemented at Azienda Ospedale-Università Padova, is a Fracture Liaison Service (FLS) program to evaluate patients aged > 50 years old admitted with fragility hip fractures, involving an interdisciplinary team. After the identification of patients with hip fractures in the Emergency Department, a comprehensive evaluation is conducted to identify risk factors for further fractures, and to assess the main domains of multidimensional geriatric assessment, including muscle status. Patients are then prescribed with anti-fracture therapy, finally undergoing periodic follow-up visits. RESULTS During the first five months, a total of 250 patients were evaluated (70.4% women, median age 85 years). Following assessment by the Hip-POS team, compared to pre-hospitalization, the proportion of patients not receiving antifracture therapy decreased significantly from 60 to 21%. The prescription rates of vitamin D and calcium increased markedly from 29.6% to 81%. CONCLUSIONS We introduced the Hip-POS program for the care of older adults with hip fractures. We aspire that our model will represent a promising approach to enhancing post-fracture care by addressing the multifactorial nature of osteoporosis and its consequences, bridging the gap in secondary fracture prevention, and improving patient outcomes.
Collapse
Affiliation(s)
- G P Arcidiacono
- Clinica Medica 1, Department of Medicine, Azienda Ospedale-Università Padova, Padua, Italy
| | - C Ceolin
- Department of Medicine - DIMED, Division of Metabolic Disease (DIMED), University of Padova, Padua, Italy.
- Geriatric Unit, Department of Medicine, University Hospital of Padova, Padua, Italy.
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - S Sella
- Clinica Medica 1, Department of Medicine, Azienda Ospedale-Università Padova, Padua, Italy
| | - V Camozzi
- Endocrinology Unit, Department of Medicine, Azienda Ospedale-Università Padova, Padua, Italy
| | - A Bertocco
- Geriatric Unit, Department of Medicine, University Hospital of Padova, Padua, Italy
| | - M O Torres
- Clinica Medica 1, Department of Medicine, Azienda Ospedale-Università Padova, Padua, Italy
| | - M G Rodà
- Orthopedics and Orthopedic Oncology Unit, Azienda Ospedale-Università Padova, Padua, Italy
| | - M Cannito
- Endocrinology Unit, Department of Medicine, Azienda Ospedale-Università Padova, Padua, Italy
| | - A Berizzi
- Orthopedics and Traumatology Unit, Azienda Ospedale-Università Padova, Padua, Italy
| | - G Romanato
- Orthopedics and Traumatology Unit, Azienda Ospedale-Università Padova, Padua, Italy
| | - A Venturin
- Physical Medicine and Rehabilitation Unit, Azienda Ospedale-Università Padova, Padua, Italy
| | - V Cianci
- Emergency Department, Azienda Ospedale-Università Padova, Padua, Italy
| | - A Pizziol
- Emergency Department, Azienda Ospedale-Università Padova, Padua, Italy
| | - E Pala
- Orthopedics and Orthopedic Oncology Unit, Azienda Ospedale-Università Padova, Padua, Italy
| | - M Cerchiaro
- Orthopedics and Orthopedic Oncology Unit, Azienda Ospedale-Università Padova, Padua, Italy
| | - S Savino
- Department of Medicine, Università Di Padova, Padua, Italy
| | - M Tessarin
- Department of Directional Hospital Management, Azienda Ospedale-Università Padova, Padua, Italy
| | - P Simioni
- Clinica Medica 1, Department of Medicine, Azienda Ospedale-Università Padova, Padua, Italy
| | - G Sergi
- Geriatric Unit, Department of Medicine, University Hospital of Padova, Padua, Italy
| | - P Ruggieri
- Orthopedics and Orthopedic Oncology Unit, Azienda Ospedale-Università Padova, Padua, Italy
| | - S Giannini
- Clinica Medica 1, Department of Medicine, Azienda Ospedale-Università Padova, Padua, Italy
| |
Collapse
|
4
|
Danazumi MS, Lightbody N, Dermody G. Effectiveness of fracture liaison service in reducing the risk of secondary fragility fractures in adults aged 50 and older: a systematic review and meta-analysis. Osteoporos Int 2024; 35:1133-1151. [PMID: 38536447 PMCID: PMC11211169 DOI: 10.1007/s00198-024-07052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/01/2024] [Indexed: 06/28/2024]
Abstract
To determine and appraise the certainty of fracture liaison service (FLS) in reducing the risk of secondary fragility fractures in older adults aged ≥ 50 years and to examine the nature of the FLS and the roles of various disciplines involved in the delivery of the FLS. Medline, EMBASE, PubMed, CINAHL, SCOPUS, and The Cochrane Library were searched from January 1st, 2010, to May 31st, 2022. Two reviewers independently extracted data. The risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the PEDro scale for randomized trials, while the GRADE approach established the certainty of the evidence. Thirty-seven studies were identified of which 34 (91.9%) were rated as having a low risk of bias and 22 (59.5%) were meta-analyzed. Clinically important low certainty evidence at 1 year (RR 0.26, CI 0.13 to 0.52, 6 pooled studies) and moderate certainty evidence at ≥ 2 years (RR 0.68, CI 0.55 to 0.83, 13 pooled studies) indicate that the risk of secondary fragility fracture was lower in the FLS intervention compared to the non-FLS intervention. Sensitivity analyses with no observed heterogeneity confirmed these findings. This review found clinically important moderate certainty evidence showing that the risk of secondary fragility fracture was lower in the FLS intervention at ≥ 2 years. More high-quality studies in this field could improve the certainty of the evidence. Review registration: PROSPERO-CRD42021266408.
Collapse
Affiliation(s)
- Musa Sani Danazumi
- Discipline of Physiotherapy, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
- Department of Physiotherapy, Federal Medical Centre Nguru, 02 Machina Road, Nguru, 630101, Yobe, Nigeria
| | - Nicol Lightbody
- Queensland Government Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Gordana Dermody
- School of Health, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, 4556, Australia.
| |
Collapse
|
5
|
Tahmasbi F, Sadoughi F, Sheikhtaheri A, Zabihiyeganeh M, Ameri F. Developing fracture liaison service framework based on comparative analysis and scoping review. Osteoporos Int 2024:10.1007/s00198-024-07091-8. [PMID: 38831198 DOI: 10.1007/s00198-024-07091-8] [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: 12/18/2023] [Accepted: 04/16/2024] [Indexed: 06/05/2024]
Abstract
This research conducts a comparative analysis and scoping review of 105 studies in the field of Fracture Liaison Service (FLS). The resulting two-dimensional framework represents a significant step toward FLS implementation. PURPOSE The primary goal is to review interventions in real world settings in order to provide the FLS framework that specifies the essential elements of its implementation and offers different perspectives on that. METHOD This study encompasses two phases: a comparative analysis of existing FLS models, including "Capture the Fracture," "5IQ," and "Ganda," and a scoping review from 2012 to 2022 in PubMed, Web of Science, Scopus, ProQuest, and IEEE databases limited to publications in English. RESULTS The resulting model of comparative analysis identifies patient identification, investigation, intervention and integration or continuity of care as the four main stages of FLS. Additionally, the elements of quality and information span across all stages. Following comparative analysis, the framework is designed to be used for content analysis of the included studies in the scoping review. The intersection of columns (Who, Where, When, What, How, Quality) with rows (Identification, Investigation, Intervention, and continuity of care) yields a set of questions, answered in tabular form based on the scoping review. CONCLUSION The framework offers potential benefits in facilitating the adoption of effective approaches for FLS implementation. It is recommended to undertake an in-depth review of each of these components in order to uncover novel and innovative approaches for improving their implementation.
Collapse
Affiliation(s)
- Foziye Tahmasbi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhdeh Zabihiyeganeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Ameri
- School of Manufacturing Systems and Networks, Arizona State University, Arizona, AZ, USA
| |
Collapse
|
6
|
Billups SJ, Fixen DR, Schilling LM, El-Sheikh A, Marcus AM, Rothman MS. Lessons Learned: Evaluation of Fracture Liaison Service Quality Improvement Efforts in a Large Academic Healthcare System. J Gen Intern Med 2024; 39:1407-1413. [PMID: 38100010 PMCID: PMC11169298 DOI: 10.1007/s11606-023-08568-8] [Citation(s) in RCA: 1] [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: 05/09/2023] [Accepted: 12/04/2023] [Indexed: 06/13/2024]
Abstract
BACKGROUND The Fracture Liaison Service (FLS) care model, a care coordination program for patients experiencing a fragility fracture, is proven to improve management of patients with an osteoporotic fracture, but treatment initiation gaps persist. OBJECTIVE We describe the evolution of a centralized FLS within a university-based healthcare system, including impact of adding clinical pharmacist consultation, and describe circumstances surrounding continued care gaps. DESIGN Cohort analysis of osteoporosis medication initiation before FLS, after initial implementation, and after addition of pharmacist consultation. PATIENTS Individuals aged 65 and older experiencing any fragility fracture between 7/1/16 and 3/31/22. INTERVENTION A centralized team outreached eligible patients, ordered dual x-ray absorptiometry and laboratory tests as needed, and scheduled an osteoporosis-focused primary care appointment. Three years after FLS implementation, clinical pharmacist consultative review was added prior to the primary care visit. MAIN MEASURES Initiation of osteoporosis pharmacologic therapy, completion of DXA, primary care follow-up rate, and description of circumstances where therapy was not initiated. KEY RESULTS Of 1204 new fractures between 7/1/16 and 3/31/22, 315 patients were enrolled in one of two FLS phases, and 89 eligible historical controls were identified. Medication initiation rates went from 22/89 (25%) pre-FLS to 201/428 (47%) after-FLS phase 1 [POST1] (p<0.001) and to 106/187 (57%) after FLS phase 2 (POST2), when clinical pharmacist consultation was added (p=0.03 versus POST1). DXA was completed in 56/89 (67%) of pre-FLS patients, 364/428 (85%) POST1 patients (p<0.001 versus pre), and 163/187 (87%) POST2 (p< 0.001 versus PRE, p=0.59 versus POST1). Of 375 patients who did not initiate osteoporosis medication, more in the combined post-FLS cohorts attended a follow-up primary care appointment (233/308, 76% attended, versus pre-FLS 41/67, 61%, p=0.016). CONCLUSION An FLS including centralized outreach and care coordination significantly improved patient follow-up, DXA, and medication initiation. Addition of de-centralized pharmacist consultation further improved medication initiation rates.
Collapse
Affiliation(s)
- Sarah J Billups
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
| | - Danielle R Fixen
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | - Arwa El-Sheikh
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | | |
Collapse
|
7
|
Ali A, Huszti E, Noordin S, Ali U, Sale JEM. Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis. Osteoporos Int 2024:10.1007/s00198-024-07078-5. [PMID: 38740589 DOI: 10.1007/s00198-024-07078-5] [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: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This systematic review seeks to evaluate the proportion of fragility fracture patients screened in secondary fracture prevention programs who were indicated for pharmacological treatment, received prescriptions for bone-active medications, and initiated the prescribed medication. Additionally, the study aims to analyze equity in pharmacological treatment by examining equity-related variables including age, sex, gender, race, education, income, and geographic location. METHODS We conducted a systematic review to ascertain the proportion of fragility fracture patients indicated for treatment who received prescriptions and/or initiated bone-active medication through secondary fracture prevention programs. We also examined treatment indications reported in studies and eligibility criteria to confirm patients who were eligible for treatment. To compute the pooled proportions for medication prescription and initiation, we carried out a single group proportional meta-analysis. We also extracted the proportions of patients who received a prescription and/or began treatment based on age, sex, race, education, socioeconomic status, location, and chronic conditions. RESULTS This review included 122 studies covering 114 programs. The pooled prescription rate was 77%, and the estimated medication initiation rate was 71%. Subgroup analysis revealed no significant difference in treatment initiation between the Fracture Liaison Service and other programs. Across all studies, age, sex, and socioeconomic status were the only equity variables reported in relation to treatment outcomes. CONCLUSION Our systematic review emphasizes the need for standardized reporting guidelines in post-fracture interventions. Moreover, considering equity stratifiers in the analysis of health outcomes will help address inequities and improve the overall quality and reach of secondary fracture prevention programs.
Collapse
Affiliation(s)
- Anum Ali
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada.
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Shahryar Noordin
- Department of Surgery, Aga Khan University, National Stadium Rd, P.O. Box 3500, Karachi City, Sindh, Pakistan
| | - Usman Ali
- Department of Surgery, Aga Khan University, National Stadium Rd, P.O. Box 3500, Karachi City, Sindh, Pakistan
| | - Joanna E M Sale
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 5th Floor - 149 College Street, Toronto, ON, M5B 1W8, Canada
| |
Collapse
|
8
|
González-Quevedo D, Rubia-Ortega C, Sánchez-Delgado A, Moriel-Garceso D, Sánchez-Siles JM, Bravo-Bardají M, García-de-Quevedo D, Tamimi I. Secondary osteoporosis prevention: three-year outcomes from a Fracture Liaison Service in elderly hip fracture patients. Aging Clin Exp Res 2024; 36:103. [PMID: 38704788 PMCID: PMC11070393 DOI: 10.1007/s40520-024-02761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Hip fractures are the most serious fragility fractures due to their associated disability, higher hospitalization costs and high mortality rates. Fracture Liaison Service (FLS) programs have enhanced the management of osteoporosis-related fractures and have shown their clinical effectiveness. AIMS To analyze the effect of the implementation of a FLS model of care over the survival and mortality rates following a hip fracture. METHODS We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture before and after the implementation of the FLS in our center (between January 2016 and December 2019). Patients were followed for three years after the index date. Mortality, complications and refracture rates were compared between the two groups using a Multivariate Cox proportional hazard model. RESULTS A total of 1366 patients were included in this study (353 before FLS implementation and 1013 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (79.3% vs 12.5%; p < 0.01) and there was an increase in adherence to treatment (51.7% vs 30.2%; p < 0.01). A total of 413 (40.8%) patients after FLS implementation and 141 (39.9%) individuals before (p = 0.47) died during the three-years follow-up period. A second fracture occurred in 101 (10.0%) patients after FLS implementation and 37 (10.5%) individuals before (p = 0.78). Patients after the implementation of the FLS protocol had a lower all cause one-year mortality [adjusted Hazard Ratio (HR) 0.74 (0.57-0.94)] and a decreased risk of suffering a second osteoporotic fracture [adjusted HR 0.54 (0.39-0.75) in males and adjusted HR 0.46 (0.30-0.71) in females]. CONCLUSIONS The implementation of a FLS protocol was associated with a lower all-cause one-year mortality rate and a higher survivorship in elderly hip fracture patients. However, no three-year mortality rate differences were observed between the two groups. We also found a reduction in the complication and second-fracture rates.
Collapse
Affiliation(s)
- David González-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain.
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain.
| | - Carolina Rubia-Ortega
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Adriana Sánchez-Delgado
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Diego Moriel-Garceso
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Juan-Manuel Sánchez-Siles
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Manuel Bravo-Bardají
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - David García-de-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Iskandar Tamimi
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| |
Collapse
|
9
|
Ishizu H, Shimizu T, Arita K, Sato K, Takahashi R, Kusunoki K, Shimodan S, Asano T, Iwasaki N. Secondary fracture and mortality risk with very high fracture risk osteoporosis and proximal femoral fracture. J Bone Miner Metab 2024; 42:196-206. [PMID: 38308695 DOI: 10.1007/s00774-023-01492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/06/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION We aimed to investigate secondary fracture and mortality rates, and risk factors in patients with proximal femoral fractures. MATERIALS AND METHODS We conducted a multicenter prospective cohort study on female patients with proximal femoral fractures who underwent surgical treatment between April 2020 and March 2021. Postoperative follow-ups were performed at 6-, 12-, 18-, and 24-month intervals to determine the secondary fracture and mortality rates, and the risk factors and its influence were examined. RESULTS Of the 279 registered patients, 144 patients (51.6%) were diagnosed with very high fracture risk osteoporosis. The postoperative osteoporosis rate exceeded 96%; however, osteoanabolic agents were used sparingly. The risk factor of both secondary fracture and mortality was very high fracture risk osteoporosis, and secondary fractures within 12 months were markedly occurred. Secondary fracture rates increased as the number of matched very high fracture risk osteoporosis criteria increased. Notably, secondary fractures and mortality were recorded in 21.4% and 23.5% of the patients who met all criteria, respectively. CONCLUSION Over half of the female patients with proximal femoral fractures had very high fracture risk osteoporosis. Although, very high fracture risk osteoporosis demonstrated a notably increased risk of secondary fractures, particularly at 12 months post-surgery, the use of osteoanabolic agents was substantially low. Collectively, our findings highlight the need to consider the risk of very high fracture risk osteoporosis, expand the use of medications to include osteoanabolic agents, and reconsider the current healthcare approach for proximal femoral fractures.
Collapse
Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kosuke Arita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Komei Sato
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Iwamizawa City Hospital, Iwamizawa, Hokkaido, Japan
| | - Renya Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Kenichi Kusunoki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Central Hospital, Hakodate, Hokkaido, Japan
| | - Shun Shimodan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Tsuyoshi Asano
- Department of Orthopaedic Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| |
Collapse
|
10
|
Rezae F, Kelly A, Dey S, Moles R, Carter S. Healthcare professionals' perspectives and experiences of osteoporosis medication treatment: a qualitative systematic review. Arch Osteoporos 2024; 19:8. [PMID: 38191760 DOI: 10.1007/s11657-023-01359-y] [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: 08/15/2023] [Accepted: 11/25/2023] [Indexed: 01/10/2024]
Abstract
This systematic review aimed to explore healthcare professionals' (HCPs) experiences and perspectives of osteoporosis medication treatment through thematic synthesis of qualitative studies. We found themes about how osteoporosis is perceived as a disease, treatment decision-making and what empowers HCPs to provide the best possible care. PURPOSE The systematic review aimed to describe the perspectives and experiences of HCPs regarding osteoporosis medication treatment. METHODS We performed searches in four electronic databases (Medline, Embase, PsycINFO and CINAHL) from database inception until May 2023 in any language. Data was analysed through inductive thematic synthesis. RESULTS We included 27 primary studies that incorporated the views of 495 different HCPs. The following themes were identified: low-priority disease, challenges in treatment decision-making, minimising drug burden, conscious of communication barriers, fragmented care and advice, confidence through experience and collaboration. CONCLUSIONS HCPs were enthusiastic about optimising osteoporosis care through interprofessional collaboration and expertise, as well as educating and monitoring patients on treatment. They advocated for safety, comfort and reducing overall drug burden, especially in older patients with comorbidities. However, they had differences in opinions regarding who has responsibility for diagnosing and treating osteoporosis and struggled to provide the best possible care due to competing priorities, limited time and lack of adequate knowledge or evidence. The findings highlight the important and complementary role of different HCPs in osteoporosis treatment through a multidisciplinary model of care.
Collapse
Affiliation(s)
- Fatima Rezae
- School of Pharmacy, University of Sydney, Sydney, Australia.
| | - Ayano Kelly
- Rheumatology Department, Liverpool Hospital, Sydney, Australia
- Ingham Institute of Applied Medical Research, Sydney, Australia
- School of Health and Medicine, South Western Sydney Campus, University of New South Wales, Sydney, Australia
| | - Sagarika Dey
- School of Clinical Medicine, South Western Sydney Campus, University of New South Wales, Sydney, Australia
| | - Rebekah Moles
- School of Pharmacy, University of Sydney, Sydney, Australia
| | - Stephen Carter
- School of Pharmacy, University of Sydney, Sydney, Australia
| |
Collapse
|
11
|
Lu K, Wu YM, Shi Q, Gong YQ, Zhang T, Li C. A novel fracture liaison service using digital health: impact on mortality in hospitalized elderly osteoporotic fracture patients. Osteoporos Int 2024; 35:53-67. [PMID: 37698600 DOI: 10.1007/s00198-023-06905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
We examined the performance of an intelligent fracture liaison service (FLS) assisted by digital health (DH) to reduce all-cause mortality (ACM) risk. According to our findings, the new FLS reduced ACM by 36%. INTRODUCTION A well-designed secondary prevention program known as FLS enhances the bone densitometry-based assessment rate as well as osteoporosis (OP) medication usage following a fracture. However, there are only a few reports on FLS incorporating DH, and it remains unclear whether this integration has influenced patient ACM, which refers to the overall death rate from any cause during the study period. METHODS This retrospective observational study was conducted on data from the Fragility Fracture Registration System database linked to the Regional Health Registration Platform of Kunshan City and the Population Death Registration System of Jiangsu Province for one tertiary-level A hospital in China. Patients aged ≥ 50 years, who experienced an OP fracture between January 1, 2017, and July 27, 2022, requiring hospitalization, were selected for analysis. We compared the outcomes of patients who received routine fragility fracture management (the no-FLS group) or FLS (the FLS group). We employed multivariable Cox regression with inverse probability weighting based on the propensity score (PS). RESULTS Of 2317 patients, 756 (32.6%) received FLS and 1561 (67.4%) did not. Using PS matching, we minimized the baseline characteristic differences between the two groups in the propensity score-matched samples, relative to the unmatched samples. Based on our analysis, the new FLS reduced ACM by 36% (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.47 to 0.87; P-value = 0.004). Moreover, FLS patients experienced further reductions in fall-related mortality, refracture rate, and total refracture-related hospital costs, and had increased dual-energy X-ray absorptiometry (DXA) testing and treatment initiation rates, relative to the no-FLS patients. CONCLUSIONS A new FLS model implementation assisted by DH can effectively reduce ACM among elderly patients with OP fractures requiring surgery. In future investigations, we recommend examining the scalability of this model.
Collapse
Affiliation(s)
- Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - Ya-Ming Wu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - Qin Shi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, Jiangsu, China
| | - Ya-Qin Gong
- Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Ting Zhang
- Chronic Disease Department, Kunshan Center For Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Chong Li
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China.
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Charoenngam N, Pongchaiyakul C. Current issues in evaluation and management of osteoporosis in Thailand. Osteoporos Sarcopenia 2023; 9:53-59. [PMID: 37496986 PMCID: PMC10366423 DOI: 10.1016/j.afos.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/27/2023] [Accepted: 05/19/2023] [Indexed: 07/28/2023] Open
Abstract
Osteoporosis is a major public health issue in Thailand, which increased morbidity, mortality, and health-care utilization. The objective of this review is to provide current perspectives on epidemiology, evaluation and management of osteoporosis in Thailand. According to epidemiologic data, the prevalence of osteoporosis and the incidence of hip fracture were comparable to the rest of the world. However, among Thai postmenopausal women, the prevalence of asymptomatic vertebral fracture was disproportionately high. In addition to established risk factors, conditions that may affect the risk of osteoporosis in the Thai population include certain genetic variants, thalassemia, vitamin D deficiency, and low dietary calcium intake, which requires further investigations to draw conclusions. In 2021, the Thai Osteoporosis Foundation released a new Clinical Practice Guideline that provides up-to-date evidence-based recommendations for evaluation and management of osteoporosis. Nonetheless, more research is required to provide local evidence in a variety of areas to guide management of osteoporosis in Thailand. These include epidemiology of distal radial fracture, the optimal intervention threshold of the Thai-specific Fracture Risk Assessment Tool model, screening for asymptomatic vertebral fracture, and the economic evaluation of osteoporosis management options, including fracture liaison service.
Collapse
Affiliation(s)
- Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| |
Collapse
|
15
|
Ishizu H, Shimizu T, Yamazaki S, Ohashi Y, Sato K, Shimodan S, Iwasaki N. Secondary fracture rates and risk factors 1 year after a proximal femoral fracture under FLS. J Bone Miner Metab 2023:10.1007/s00774-023-01426-x. [PMID: 37037921 PMCID: PMC10088666 DOI: 10.1007/s00774-023-01426-x] [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: 12/03/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION We aimed to investigate the secondary fracture rates and risk factors in patients with proximal femoral fractures using fracture liaison service (FLS) during the coronavirus disease (COVID)-19 pandemic. MATERIALS AND METHODS In this multi-center prospective cohort study, patients with proximal femoral fractures who were treated surgically at three hospitals from April 2020 to March 2021 were included. Follow-up examinations at 6 and 12 months postoperatively were conducted to investigate the clinical data and ascertain whether osteoporosis treatment could be continued. RESULTS A total of 316 patients with proximal femoral fractures were registered. During the follow-up period, 17 patients died and 67 patients could not visit the hospitals owing to the COVID-19 pandemic. In total, 172 patients who could be followed-up 12 months postoperatively were examined using dual-energy X-ray absorptiometry during hospitalization; underwent postoperative osteoporosis treatment, mainly with bisphosphonates (89.5%); and were administered medications continuously. Secondary fractures occurred within 1 year in 14 patients (8.1%). Multivariate analysis showed that patients who used sleeping pills and had a lower functional independence measure had an increased risk for developing secondary fractures. CONCLUSION During the COVID-19 pandemic, secondary fractures can be prevented if the patients can be followed and osteoporosis treatment can be continued. Conversely, despite adequate osteoporosis drug examination and treatment, a certain number of secondary fractures still occurred. The finding that postoperative osteoporosis therapy using routine medications and rehabilitation is associated with secondary fractures may support the importance of establishing clinical standards consisting of a multidisciplinary collaboration for FLS.
Collapse
Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Central Hospital, Hakodate, Hokkaido, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Shu Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Yusuke Ohashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Central Hospital, Hakodate, Hokkaido, Japan
| | - Komei Sato
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopedic Surgery, Iwamizawa City Hospital, Iwamizawa, Hokkaido, Japan
| | - Shun Shimodan
- Department of Orthopedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| |
Collapse
|
16
|
Kanis JA, McCloskey EV, Harvey NC, Cooper C, Rizzoli R, Dawson-Hughes B, Maggi S, Reginster JY. The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis. Osteoporos Int 2023; 34:1-9. [PMID: 36282342 DOI: 10.1007/s00198-022-06567-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/30/2022] [Indexed: 01/07/2023]
Abstract
This position paper of the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) addresses the rationale for separate diagnostic and intervention thresholds in osteoporosis. We conclude that the current BMD-based diagnostic criteria for osteoporosis be retained whilst clarity is brought to bear on the distinction between diagnostic and intervention thresholds.
Collapse
Affiliation(s)
- John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Rene Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liege, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liege, Belgium
| |
Collapse
|
17
|
Halim NK, Harris RG, Cameron ID, Close J, Harris IA, Hallen J, Hurring S, Ward N, McDougall C, Mitchell RJ. Two-country comparison of the prescription of bone protection medication before and early after hip fracture. Arch Osteoporos 2022; 18:8. [PMID: 36508017 DOI: 10.1007/s11657-022-01197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
Pharmacological management of bone health warrants investigation into factors influencing initiation of bone protection medication (BPM) at discharge after a hip fracture. This sprint audit identified reasons attributed to low BPM treatment levels at hospital discharge which can guide improvement in the prevention of future fractures. PURPOSE To compare patient characteristics and Australian and New Zealand approaches to prescribing bone protection medication (BPM) pre- or post-hip fracture, determine reasons why BPM was not prescribed earlier post-fracture, and assess the generalisability of sprint audit and the Australian and New Zealand Hip Fracture Registry (ANZHFR) patient cohorts. METHODS A retrospective cohort study of hip fracture patients from the ANZHFR aged ≥ 50 years (2016-2020) and consecutive patients from the 2021 BPM sprint audit. Multivariable logistic regression was used to examine factors associated with not prescribing BPM. RESULTS Of 55,618 patients admitted with a hip fracture in the ANZHFR, less than 10% of patients in Australia and New Zealand were taking BPM on admission, increasing to 22.4% in Australia and 27.8% in New Zealand on discharge. Registry patients who were younger (50-69 years), healthy (ASA grade 1), lived in a residential aged care facility, had impaired cognition, delirium identified, or were awaiting a specialist falls assessment were less likely to take BPM. Within the audit, 46.2% of patients in Australia and 39.2% in New Zealand did not have BPM in their discharge prescription. The most common reason for not prescribing BPM in Australia was low level of vitamin D (13.3%), and in New Zealand, renal impairment (14.8%). Sprint and registry patient characteristics were comparable in terms of patient age, sex, usual place of residence, and ASA grade. CONCLUSIONS BPM prescription early after hip fracture is low. Opportunities exist to increase the rate of prescription of medications known to prevent future fractures in this high-risk population.
Collapse
Affiliation(s)
- Nicole K Halim
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Roger G Harris
- Australian and New Zealand Hip Fracture Registry Steering Group, Auckland, New Zealand
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, School of Clinical Medicine, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Jamie Hallen
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Sarah Hurring
- Canterbury District Health Board, Christchurch, New Zealand
| | - Nicola Ward
- Australian and New Zealand Hip Fracture Registry Steering Group, Auckland, New Zealand
| | - Catherine McDougall
- Surgical Treatment and Rehabilitation Service (STARS) and The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland and Faculty of Medicine, University of Queensland, St Lucia, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| |
Collapse
|
18
|
Bogoch E, Marcano-Fernández FA, Schemitsch EH, Zhou Q, Bzovsky S, Bhandari M, Schneider PS, Swiontkowski M, Sprague S. High Rates of Imminent Subsequent Fracture After Femoral Neck Fracture in the Elderly. J Bone Joint Surg Am 2022; 104:1984-1992. [PMID: 36017942 DOI: 10.2106/jbjs.22.00088] [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: 02/04/2023]
Abstract
BACKGROUND Fragility fractures of the hip are known to be followed frequently by subsequent fragility fractures, including second hip fractures. Data on subsequent fractures are available for aggregated index femoral neck and intertrochanteric femoral fractures, grouped generically as hip fractures, but not specifically for femoral neck fractures. There is increasing recognition that a subsequent fracture often occurs early after a hip fracture in the elderly, creating an emphasis on the concept of "imminent fracture risk." Since 2000, there have been many reports on the care gap in interventions after a fragility fracture, with concern regarding the slow uptake of appropriate systemic treatments designed to prevent a subsequent fracture in high-risk patients. METHODS As planned a priori, we performed an analysis of subsequent fractures after an index femoral neck fracture in 2 prospective clinical trials involving 2,520 patients from 90 sites on 5 continents. We recorded the incidence and time of occurrence of all secondary fragility fractures as well as the reported use of bone-protective medication in all subjects. RESULTS In the 24 months following the index femoral neck fracture, 226 (9.0%) of 2,520 patients sustained at least 1 subsequent fragility fracture, including 113 hip fractures (4.5%). The median interval from the index fracture to a subsequent fracture was approximately 9.0 months. Only 25.2% (634) of the 2,520 patients reported using bone-protective medications at any time during follow-up. Female patients, those with nondisplaced index fractures, and those treated with arthroplasty, were more likely to have received protective medication. CONCLUSIONS Subsequent fractures, including second hip fractures, occurred frequently and early following an index femoral neck fracture in 2 large global cohorts. Interventions to prevent a subsequent fracture were instituted in only 1 of 4 patients, even though a focused directive was included in both study protocols. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Earl Bogoch
- Department of Surgery, University of Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Francesc A Marcano-Fernández
- Orthopaedic Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Emil H Schemitsch
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Prism S Schneider
- Division of Orthopaedic Trauma, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Marc Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Sheila Sprague
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | | |
Collapse
|
19
|
Ruggiero C, Baroni M, Talesa GR, Cirimbilli A, Prenni V, Bubba V, Parretti L, Bogini R, Duranti G, Caraffa A, Boccardi V, Mecocci P, Rinonapoli G. The interdisciplinary fracture liaison service improves health-related outcomes and survival of older adults after hip fracture surgical repair. Arch Osteoporos 2022; 17:135. [PMID: 36251126 PMCID: PMC9576663 DOI: 10.1007/s11657-022-01171-0] [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: 04/25/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
Due to the high burden of fragility fractures, we developed an interdisciplinary FLS care pathway for early management and monitoring of older adults discharged from a high-volume trauma center after hip fracture repair. Interdisciplinary FLS effectively improves up to 1-year adherence to treatments for secondary prevention of fragility fractures, reduces health facility admission, and improves long-term survival. PURPOSE To compare adherence to secondary fragility fracture prevention, falls, healthcare facility admissions, and mortality between hip fracture older adults who entered the fracture liaison services pathway of care (FLS-CP) and those managed according to the usual traumatologist model of care (U-CP). METHODS Prospective observational study enrolling subjects aged ≥ 65 years discharged by high-volume trauma center after hip fracture repair from February 2016 to February 2017, who consecutively entered FLS-CP or U-CP according to their preference and goals. RESULTS Compared to U-CP, those in FLS-CP had higher initiation rate and up to 1-year adherence to secondary prevention of fragility fracture, including vitamin D and calcium (87.7% vs 36.9%; p < 0.0001), specific anti-osteoporosis drugs (75.1% vs 8.0%; p < 0.0001), and complete anti-fracture therapy (72.3% vs 5.7%; p < 0.0001). Older adults belonging to FLS-CP showed a lower likelihood of healthcare facility admission (RR 0.597; 95% CI 0.398-0.895; p = 0.0125), with a longer re-hospitalization-free survival (176.4 vs 88.7 days; p = 0.0152) than those in U-CP. One-year incidence of falls and fractures was similar between groups, with a lower tendency of the subjects in the FLS-CP to be multiple fallers (19% vs 34.8%; OR 0.057; 95% CI 0.004-0.876; p = 0.0690). The FLS-CP group experienced a lower 1-year (87.2% vs 74.3%; p = 0.001) and 3-year mortality (67.9% vs 55.6%; p = 0.0245) and a lower adjusted 5-year mortality hazard ratio (50.2% vs 58%; HR = 0.76; 95% CI 0.60; 0.96). CONCLUSION The FLS-CP may improve initiation and adherence to secondary prevention of fragility fractures, reduces healthcare facility admission, and improves long-term survival.
Collapse
Affiliation(s)
- Carmelinda Ruggiero
- Section of Gerontology and Geriatric, Department of Medicine and Surgery, S.M. Misericordia Hospital of Perugia, University of Perugia, S. Andrea Delle Fratte, Perugia, Italy.
| | - Marta Baroni
- Section of Gerontology and Geriatric, Department of Medicine and Surgery, S.M. Misericordia Hospital of Perugia, University of Perugia, S. Andrea Delle Fratte, Perugia, Italy
| | - Giuseppe Rocco Talesa
- Section of Orthopedics and Traumatology, Department of Medicine and Surgery, S.M. Misericordia Hospital, University of Perugia, Sant'Andrea Delle Fratte, Perugia, Italy
| | - Alessandro Cirimbilli
- Section of Orthopedics and Traumatology, Department of Medicine and Surgery, S.M. Misericordia Hospital, University of Perugia, Sant'Andrea Delle Fratte, Perugia, Italy
| | - Valentina Prenni
- Section of Gerontology and Geriatric, Department of Medicine and Surgery, S.M. Misericordia Hospital of Perugia, University of Perugia, S. Andrea Delle Fratte, Perugia, Italy
| | - Valentina Bubba
- Section of Gerontology and Geriatric, Department of Medicine and Surgery, S.M. Misericordia Hospital of Perugia, University of Perugia, S. Andrea Delle Fratte, Perugia, Italy
| | - Luca Parretti
- Section of Gerontology and Geriatric, Department of Medicine and Surgery, S.M. Misericordia Hospital of Perugia, University of Perugia, S. Andrea Delle Fratte, Perugia, Italy
| | | | | | - Auro Caraffa
- Section of Orthopedics and Traumatology, Department of Medicine and Surgery, S.M. Misericordia Hospital, University of Perugia, Sant'Andrea Delle Fratte, Perugia, Italy
| | - Virginia Boccardi
- Section of Gerontology and Geriatric, Department of Medicine and Surgery, S.M. Misericordia Hospital of Perugia, University of Perugia, S. Andrea Delle Fratte, Perugia, Italy
| | - Patrizia Mecocci
- Section of Gerontology and Geriatric, Department of Medicine and Surgery, S.M. Misericordia Hospital of Perugia, University of Perugia, S. Andrea Delle Fratte, Perugia, Italy
| | - Giuseppe Rinonapoli
- Section of Orthopedics and Traumatology, Department of Medicine and Surgery, S.M. Misericordia Hospital, University of Perugia, Sant'Andrea Delle Fratte, Perugia, Italy
| |
Collapse
|
20
|
Kadri A, Binkley N, Daffner SD, Anderson PA. Clinical risk factor status in patients with vertebral fracture but normal bone mineral density. Spine J 2022; 22:1634-1641. [PMID: 35680015 DOI: 10.1016/j.spinee.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Normal bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DXA) is present in approximately 10% of older adults with fracture. BMD alone does not evaluate bone quality or clinical risk factors, and therefore, may not adequately capture a patient's fracture risk. Thus, despite a normal DXA-measured BMD, the underlying bone may be abnormal, suggesting that further bone health evaluation, and potentially, pharmacologic treatment may be warranted. PURPOSE To determine the prevalence of normal BMD, clinical fracture risk factors, and quantitative risk of fracture using the Fracture Risk Assessment Tool (FRAX) in vertebral fracture patients with normal BMD enrolled in the Own the Bone registry, thus facilitating identification of those who meet criteria for anti-osteoporosis therapy. STUDY DESIGN/SETTING Retrospective, national registry-based cohort. PATIENT SAMPLE From July 2016 to July 2021, 1,807 patients age ≥50 who sustained a vertebral fracture and had DXA data available from within 2 years prior to enrollment in the American Orthopaedic Association's Own the Bone (AOA OTB) registry were included. OUTCOME MEASURES World Health Organization (WHO) DXA T-score based bone classification criteria; FRAX risk scores of major osteoporotic fracture or hip fracture. METHODS Demographic data, prior fracture site, and clinical fracture risk factors were collected. BMD status was classified by the WHO T-score criteria: ≥ -1.0 normal, -1.1 to -2.4 osteopenia, and ≤ -2.5 osteoporosis, with low bone mass including either osteopenia or osteoporosis. In normal BMD patients, FRAX scores were calculated with and without BMD, with the treatment threshold defined as a major osteoporotic fracture risk ≥20% or hip fracture risk ≥3%. RESULTS Mean±SD age was 72.0±9.7, 78.1% were female, and 92.4% were Caucasian. Normal BMD was present in 7.9%. Clinical fracture risk factors including alcohol use ≥3 units/day and history of ≥2 falls in the year prior to enrollment were more common in normal BMD (11.2% and 28%, respectively) compared to low bone mass patients (3.4% and 25.2%, respectively). A prior vertebral fracture had occurred in 49.5% with normal BMD compared to 45.8% with low bone mass, while a prior non-major osteoporotic fracture occurred in 28.9% and 29.3% of normal BMD and low bone mass patients, respectively. In normal BMD patients, either a prior fracture or FRAX risk with BMD meeting treatment thresholds was present in 85%. CONCLUSIONS Clear indications for receipt of pharmacologic therapy, ie, prior fracture or elevated fracture risk, were present in most patients with vertebral fracture and normal BMD enrolled in the AOA OTB. Prior non-major osteoporotic fractures were common and may be useful indicators of underlying bone disease. Surgeons must recognize that other important risk factors apart from BMD may indicate poor bone health, and thus, help guide further bone health evaluation.
Collapse
Affiliation(s)
- Aamir Kadri
- Department of Orthopedics & Rehabilitation, UW Medical Foundation Centennial Building, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Neil Binkley
- Osteoporosis Clinical Research Program,University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott D Daffner
- Department of Orthopaedics,West Virginia University School of Medicine, Morgantown, WV, USA
| | - Paul A Anderson
- Department of Orthopedics & Rehabilitation, UW Medical Foundation Centennial Building, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| |
Collapse
|
21
|
Secondary fracture prevention: global approaches. OTA Int 2022. [PMCID: PMC9359005 DOI: 10.1097/oi9.0000000000000193] [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: 11/26/2022]
Abstract
Osteoporotic fractures, a major cause of disability and associated medical care expenditures, are expected to continue to increase worldwide. Adults who sustain primary osteoporotic fractures are more likely to sustain additional subsequent fractures, but few receive interventions to prevent those secondary fractures. Fracture liaison service models have been developed to systematically streamline preventative care for patients who have sustained a primary fragility fracture, proving cost-effective and efficacious. These programs have been developed in many countries, with varying degrees of success. There continues to be a need to better understand the various approaches to fracture liaison service programs in different regions enabling best practices to be adopted, successful approaches to be shared, and common obstacles to be addressed. The reports in this supplement address the status of fracture liaison service programs in different countries, focusing on national standards and guidelines, successes and barriers, and future directions. This work represents a collaborative effort of member societies of the International Orthopaedic Trauma Association (IOTA), an international association of orthopaedic societies dedicated to the promotion of musculoskeletal trauma care through advancements in patient care, research, and education. The expectation is that the information in these reports will aid efforts to address the growing need for fragility fracture programs.
Collapse
|
22
|
Suhm N, Gratza SK. Novel Approach to Identify Patients With the Most to Gain From New Treatment Options Intended to Prevent Fragility Fractures. Geriatr Orthop Surg Rehabil 2022; 13:21514593221076620. [PMID: 35450300 PMCID: PMC9016568 DOI: 10.1177/21514593221076620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Norbert Suhm
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Simon K Gratza
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
23
|
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.
Collapse
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
| | | |
Collapse
|
24
|
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]
|
25
|
Blaker K, Wijewardene A, White E, Stokes G, Chong S, Ganda K, Ridley L, Brown S, White C, Clifton-Bligh R, Seibel MJ. Electronic search programs are effective in identifying patients with minimal trauma fractures. Osteoporos Int 2022; 33:435-441. [PMID: 34510231 DOI: 10.1007/s00198-021-06105-z] [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: 03/30/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED We assessed two electronic search tools that screen medical records for documented fractures. Both programs reliably identified patients with any fracture but missed individuals with minimal trauma fracture to different degrees. A hybrid tool combining the methodology of both tools is likely to improve the identification of those with osteoporosis. PURPOSE Most patients who suffer a minimal trauma fracture remain undiagnosed, placing them at high risk of refracture. Case finding can be improved by electronic search tools that screen medical records for documented fractures. Here, we assessed the efficacy of two new programs, AES and XRAIT, in identifying patients with minimal trauma fracture. METHODS Each tool was applied to search the electronic medical record and/or radiology reports at two tertiary hospitals in Sydney, Australia, from 1 July to 31 December 2018. Samples of the extracted reports were then manually reviewed to determine the sensitivity of each program in detecting minimal trauma fractures. RESULTS At the two centers, AES detected 872 and 1364 cases, whereas XRAIT identified 1414 and 2180 patients with fractures, respectively. The true positive rate for "any fracture" was similar for both instruments (77-88%). However, the ability to detect "minimal trauma fractures" differed between programs and centers (53-75% accuracy), with each tool identifying separate subsets of patients. Concordance between both tools was less than half of the combined total number of minimal trauma fractures (43-45%). Considering the total number of minimal trauma fractures detected by both tools combined, AES correctly identified 52-55% of cases while XRAIT identified 88-93% of cases. CONCLUSION Both programs reliably identified patients with any fracture but missed individuals with minimal trauma fracture to different degrees. Hybrid tools combining the methodology of XRAIT and AES are likely to improve the identification of patients who require investigation and treatment for osteoporosis.
Collapse
Affiliation(s)
- K Blaker
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - A Wijewardene
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia.
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - E White
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - G Stokes
- Department of Endocrinology & Metabolism, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - S Chong
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - K Ganda
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
- Bone Research Program, ANZAC Research Institute, Concord, NSW, 2139, Australia
| | - L Ridley
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
- Department of Radiology, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - S Brown
- Abbot Diagnostics, Macquarie Park, NSW, 2113, Australia
| | - C White
- Department of Endocrinology & Metabolism, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - R Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - M J Seibel
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
- Bone Research Program, ANZAC Research Institute, Concord, NSW, 2139, Australia
| |
Collapse
|
26
|
Ishizu H, Shimizu H, Shimizu T, Ebata T, Ogawa Y, Miyano M, Arita K, Ohashi Y, Iwasaki N. Rheumatoid Arthritis is a Risk Factor for Refracture in Patients with Fragility Fractures. Mod Rheumatol 2021; 32:1017-1022. [PMID: 34865103 DOI: 10.1093/mr/roab109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/09/2021] [Accepted: 11/06/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To determine whether patients with rheumatoid arthritis (RA) who have had fragility fractures are at an increased risk of refractures. METHODS Patients with fragility fractures who were treated surgically at ten hospitals from 2008 to 2017 and who underwent follow-up for more than 24 months were either categorized into a group comprising patients with RA or a group comprising patients without RA (controls). The groups were matched 1:1 by propensity score matching. Accordingly, 240 matched participants were included in this study. The primary outcome was the refracture rate in patients with RA as compared to in the controls. Multivariable analyses were also conducted on patients with RA to evaluate the odds ratios (ORs) for the refracture rates. RESULTS Patients with RA were significantly associated with increased rates of refractures during the first 24 months (OR: 2.714, 95% confidence interval [95% CI]: 1.015-7.255; P = 0.040). Multivariable analyses revealed a significant association between increased refracture rates and long-term RA (OR: 6.308, 95% CI: 1.195-33.292; P=0.030). CONCLUSIONS Patients with RA who have experienced fragility fractures are at an increased risk of refractures. Long-term RA is a substantial risk factor for refractures.
Collapse
Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hirokazu Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Taku Ebata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuki Ogawa
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masahiro Miyano
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kosuke Arita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yusuke Ohashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| |
Collapse
|
27
|
Jalan H, Perumal R, Prabhu S, Palanivelayutham S, Viswanathan VK, Rajasekaran S. Intravenous bisphosphonate therapy does not delay fracture healing in inter-trochanteric femur fractures - A randomised controlled study. J Clin Orthop Trauma 2021; 20:101472. [PMID: 34178598 PMCID: PMC8213889 DOI: 10.1016/j.jcot.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 01/22/2023] Open
Abstract
Hip fractures in elderly are commonly associated with osteoporosis and surgical outcome is influenced by its concurrent management. The purpose of our study is to determine the association between timing of bisphosphonate administration in inter-trochanteric (IT) fractures and fracture healing. Patients with IT fractures (aged≥50 years) and T-score ≤ -1.5 [WHO defines osteopenia as T-score between -1 and -2.5, and osteoporosis as T-score ≤ -2.5 on DEXA scan (which was obtained post-operatively in our cohort)], who underwent proximal femoral nailing were included. Patients were divided into three groups: group 1a-intravenous bisphosphonate {ivBP [zoledronic acid (ZA)]} given within one week, group 1b-ZA at six weeks and group 2-control group. Post-operative radiographs were assessed for reduction parameters [neck-shaft angle, tip-apex distance, reduction variance]. Radiological union was determined using RUSH score and functional outcome (at one year) with Modified Harris Hip Scores. 41 (23 males), 40 (15 males) and 42 (15 males) patients were included in groups 1a, 1b and 2, respectively (no statistical difference in sex distribution among the groups; p = 0.12). Mean age in groups 1a, 1b and 2 was 71.8 ± 8.1, 75.9 ± 8.5 and 72.3 ± 10.6 years (p = 0.09). There was no significant difference in the pattern of injuries (AO classification) among the groups (p = 0.72). Mean time to union in groups 1a, 1b and 2 was 13.7,13.7 and 14.2 weeks, respectively (p = 0.69). Mean time to union in AO types A1, A2 and A3 fractures was 13.2 ± 2.1, 13.7 ± 2.8 and 16.1 ± 4.9 weeks (p = 0.01). We did not observe any association between T-scores and fracture union (hip:p = 0.52, spine:p = 0.93).The functional outcome was similar among groups (p = 0.96). Early administration of ZA did not negatively influence fracture healing in patients undergoing fixation of IT fractures. Among the various other factors analyzed, there was a statistically significant association between the fracture type (AO type A3) and longer time to fracture union.
Collapse
|