Introduction of an order set after hip fracture improves osteoporosis medication initiation and persistence: a population-based before-after analysis.

We found that a standardized order set after hip fracture increased initiation of anti-osteoporosis medication and increased persistence at 1 year, but did not reduce secondary fractures. BACKGROUND: A treatment gap exists after osteoporosis-related fractures. Introducing standardized care can improve treatment. We evaluated the impact of a hip fracture order set (OS) on anti-osteoporosis medication (AOM) initiation, persistence, and secondary fracture prevention. METHODS: In 2015, one hospital in Manitoba, Canada, introduced a hip fracture OS including recommendations for the initiation of AOM (OS group). A control group was identified from the other hospitals in the same region. A retrospective cohort study was conducted using linked administrative health data. All individuals 50 + years with surgical treatment for low-energy hip fracture between 2010 and 2019 were included and followed for AOM initiation, medication persistence at 1 year, and secondary fractures. Between-group differences for each year were assessed using chi-square tests. Logistic regression models tested the impact of socio-demographic and clinical factors on initiation, persistence of AOM. Cox regression tested the risk of secondary fracture. RESULTS: No baseline differences between OS group (813 patients) and control group (2150 patients) were observed in demographics, socioeconomic factors, or comorbidities. An increase in post-fracture AOM initiation was seen with OS introduction (OS group year before 16.7% versus year after 48.6%, p < 0.001). No change was seen in the control group. Persistence on AOM also increased (OS group year before 17.7% versus year after 28.4%, p < 0.001). No difference in secondary fractures was observed (OS group 19.8% versus control group 18.8%, p = 0.38). CONCLUSION: Introduction of a hip fracture OS significantly increased AOM initiation and persistence at 1-year post-fracture. There was no significant difference in secondary fractures.

Secondary fracture prevention in Spanish primary care: results of the PREFRAOS Study.

This study demonstrated a large treatment gap in elderly subjects experiencing fragility fracture in Spanish primary care, a low treatment persistence among subjects who do receive treatment, and more than one-quarter having no follow-up visits post-fracture. These data highlight the need to improve secondary fracture prevention in primary care. PURPOSE: To describe osteoporosis (OP) treatment patterns and follow-up in subjects with fragility fracture seen in Spanish primary care (PC). METHODS: This observational, retrospective chart review included subjects aged ≥ 70 years listed in the centers' records (November 2018 to March 2020), with ≥ 1 fragility fracture and prior consultation for any reason; subjects who had participated in another study were excluded. Outcomes included OP treatments and follow-up visits post-fragility fracture. RESULTS: Of 665 subjects included, most (87%) were women; overall mean (SD) age, 82 years. Fewer than two thirds (61%) had received any prior OP treatment (women, 65%; men, 38%); of these, 38% had received > 1 treatment (women, 25%; men, 13%). Among treated subjects, the most frequent first-line treatments were alendronate (43%) and RANKL inhibitor denosumab (22%), with a higher discontinuation rate and shorter treatment duration observed for alendronate (discontinuation, 42% vs 16%; median treatment duration, 2.5 vs 2.1 years). Over one-quarter (26%) of subjects had no follow-up visits post-fragility fracture, with this gap higher in women than men (35% versus 25%). The most common schedule of follow-up visits was yearly (43% of subjects with a fragility fracture), followed by half-yearly (17%) and biennial (10%), with a similar trend in men and women. Most OP treatments were prescribed by PC physicians, other than teriparatide and zoledronate. CONCLUSIONS: Across Spanish PC, we observed a large gap in the treatment and follow-up of elderly subjects experiencing a fragility fracture. Our data highlights the urgent need to improve secondary fracture prevention in PC.

Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis.

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.

Secondary fracture prevention in primary care: a narrative review.

The global burden of osteoporosis continues to rise with an ageing population. Untreated osteoporotic fractures not only heighten the risk of subsequent fractures but are associated with excess mortality. Although primary care guidelines consistently stress the importance of secondary fracture prevention, fewer than 20% of patients are appropriately treated for osteoporosis following an initial osteoporotic fracture. This worldwide phenomenon is known as the osteoporosis care gap. This literature review examines the barriers to secondary fracture prevention in primary care and evaluates the effectiveness of targeted primary care interventions. Common themes emerged from the majority of qualitative studies, including a need for improved communication between the hospital team and primary care, better defined responsibilities and osteoporosis-directed education for the primary care physicians. Quantitative studies demonstrated that most targeted, intensive interventions aimed at educating patients and their primary care physician about osteoporosis treatment significantly increased rates of investigation and treatment. Greater uptake of models of secondary fracture prevention in primary care is urgently needed to address the osteoporosis care gap.

Application of an in-hospital, surgeon-led anti-osteoporotic medication algorithm in patients with hip fractures improves persistence to medication and can prevent the second fragility fracture.

INTRODUCTION: Secondary fracture prevention is an essential part of hip fracture treatment. Despite this, many patients are discharged without the appropriate anti-osteoporotic medication. The aim of this study is to report the outcomes of the application of an in-hospital, surgeon-led anti-osteoporotic medication algorithm to patients with hip fractures. MATERIALS AND METHODS: This prospective cohort study followed patients with hip fractures who were treated at a tertiary referral hospital between 2020 and 2022. At discharge, anti-osteoporotic medication according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation algorithm was prescribed to all patients. Multivariate Cox regression analysis was used to investigate the risks of non-persistence to medication and of secondary fracture. RESULTS: Two hundred thirteen consecutive patients were prospectively followed. Mean follow-up was 17.2 ± 7.1 months. Persistence to medication at 2 years was 58% (95%CI 51-65%). A secondary osteoporotic fracture occurred in 1/126 (0.8%) persistent patients and 9/87 (11.4%) non-persistent patients. Multivariable Cox regression analysis confirmed that persistence to medication was significantly associated with a lower risk of secondary fracture (cause-specific hazard ratio [csHR] 0.05; 95%CI 0.01-0.45; p = 0.007). CONCLUSION: The application of the surgeon-led AO Foundation algorithm enables the in-hospital initiation of anti-osteoporotic treatment, leading to better persistence to medication and decreased incidence of secondary osteoporotic fractures.

Current approaches to secondary prevention after hip fracture in England and Wales - an analysis of trends between 2016 and 2020 using the National Hip Fracture Database (NHFD).

Hip fractures are strong risk factors for further fractures. However, using the National Hip Fracture Database, we observed that in England and Wales, 64% of patients admitted on oral bisphosphonates were discharged on the same and injectable drug use varies from 0-67% and 0.2%-83.6% were deemed "inappropriate" for bone protection. This variability requires further investigation. INTRODUCTION: A key aim for the National Hip Fracture Database (NHFD) is to encourage secondary fracture prevention of the 75,000 patients who break their hip annually in the UK, through bone health assessment and appropriate provision of anti-osteoporosis medication (AOM). We set out to describe trends in anti-osteoporosis medication prescription and examine the types of oral and injectable AOMs being prescribed both before and after a hip fracture. METHODS: We used data freely available from the NHFD  www.nhfd.co.uk  to analyse trends in oral and injectable AOM prescription across a quarter of a million patients presenting between 2016 and 2020, and more detailed information on the individual type of AOM prescribed for 63,705 patients from 171 hospitals in England and Wales who presented in 2020. RESULTS: Most patients (88.3%) are not taking any AOM when they present with a hip fracture. Half of all patients (50.8%) were prescribed AOM treatment by the time of discharge, but the proportion deemed 'inappropriate for AOM' varied hugely (0.2-83.6%) in different hospitals. Nearly two-thirds (64.2%) of those previously taking an oral bisphosphonate were simply discharged on the same type of medication. The total number of patients discharged on oral medication fell by over a quarter in these five years. The number discharged on injectables increased by nearly three-quarters to 14.2% over the same period, but remains hugely variable across the country, with rates ranging from 0-67% across different units. CONCLUSION: A recent hip fracture is a strong risk factor for future fractures. The huge variability in approaches, and in particular the use of injectables, in different trauma units across England and Wales requires further investigation.

Approach to the Patient With Bone Fracture: Making the First Fracture the Last.

The global burden of osteoporosis and osteoporotic fractures will increase significantly as we enter a rapidly aging population. Osteoporotic fractures lead to increased morbidity, mortality, and risk of subsequent fractures if left untreated. However, studies have shown that the majority of patients who suffer an osteoporotic fracture are not investigated or treated for osteoporosis, leading to an inexcusable "osteoporosis care gap." Systematic and coordinated models of care in secondary fracture prevention known as fracture liaison services (FLS) have been established to streamline and improve the care of patients with osteoporotic fractures, and employ core principles of identification, investigation, and initiation of treatment. Our approach to the multifaceted care of secondary fracture prevention at a hospital-based FLS is illustrated through several case vignettes.

An Orthopaedic Surgeon Led Osteoporosis (OSLO) Model of Care reduces early recurrent fracture rates and improves treatment compliance in patients treated for osteoporotic fractures.

This study aims to evaluate the efficacy of an Orthopaedic Surgeon Led Osteoporosis Model of Care (OSLO-MoC) in improving care of patients with primary osteoporotic fractures. The OSLO-MOC has shown to be effective in improving osteoporotic medication initiation and compliance and reducing secondary fracture rates in patients. PURPOSE: This study aims to evaluate the efficacy of an Orthopaedic Surgeon Led Osteoporosis Model of Care (OSLO-MoC) as compared to a Case Manager Led Osteoporosis Model of Care (CMLO-MoC) in reducing early osteoporotic re-fracture rates and treatment compliance in patients. METHODS: This was a single centre, retrospective, comparative cohort study of all patients screened and treated for secondary osteoporotic fracture prevention from the 2008 to 2018 at an orthopaedic surgical unit. From the 2008 to 2013, patients were recruited under the CMLO-MoC and from 2014 to 2018, under the OSLO-MOC. Logistics regression analysis was used to identify significant predictors such as OSLO-MOC implementation, gender, ethnicity, marital status and education level for patient recruitment, treatment compliance and secondary fracture rates at 12-month follow-up. RESULTS: Over a 10-year period, 7388 patients were screened of which 2855 patients were eligible for analysis. A total of 1234 patients were recruited under CMLO-MoC and 1621 patients under OSLO-MOC. Implementation of the OSLO-MOC was associated with greater patient recruitment, OR 1.26 (95%CI 1.06-1.49, P = 0.007). Of the 2855 patients recruited, OSLO-MOC implementation, OR 2.61 (95%CI 2.03-3.36, P < 0.001), and a higher level of education, OR 1.428 (95%CI 1.02-1.43, P = 0.037), were associated with improved compliance to medication at 12 months. OSLO-MOC implementation was the only factor associated with reduced risk of secondary fractures at 12 months, OR 0.14 (95%CI 0.03-0.66, P = 0.013). CONCLUSION: The OSLO-MOC has shown to be effective in reducing the rate of re-fracture and osteoporotic medication initiation and compliance of patients. LEVEL OF EVIDENCE: IV.

Osteoporosis Treatment After Osteoporotic Fractures: Data From a Single Medical Center.

OBJECTIVE: Most patients do not receive osteoporosis treatment after osteoporotic fracture. This study reviewed osteoporosis treatment after osteoporotic fractures in a center without a Fracture Liaison Service. METHODS: We identified all patients with hip, vertebral, humeral or radial fractures, evaluated in Meir Medical Center, in 2017. The exclusion criteria were not a Clalit Health Services member, high-energy fracture or 30-day postoperative mortality. The primary endpoint was osteoporosis drugs issued within 12 months of fracture. Secondary endpoints included bone densitometry and 1-year mortality. RESULTS: Five-hundred-eighty-two patients (average age 78.6 ± 11.1 years, 75.8% women) were included. There were 321 (55.5%) hip, 84 (14.1%) humeral, 33 (5.6%) vertebral, and 144 (24.7%) radial fractures. Osteoporosis drugs were issued to 26.5% of the patients; those with humeral fractures received the least (21.4%) and vertebral, the most (30.3%; P = .51). Bone densitometry was performed in 23.2% of patients. One-year mortality after hip fracture was 12.1%, followed by humeral (3.6%; P < .05). Logistic regression showed that previous treatment (odds ratio [OR] = 7.4; 95% confidence interval [CI] 3.6-15.2), bone densitometry (OR = 4.4; 95% CI 2.6-7.4) and endocrinology visit (OR = 2.6; 95% CI, 1.4-4.6) were the most important factors associated with treatment. CONCLUSION: Fewer than one third of patients received pharmacotherapy within 1 year after fracture. Because pharmacotherapy reduces future fractures and mortality, we recommend that medical staff who care for patients with fracture adopt practical and effective strategies to increase treatment rates among patients with osteoporotic fractures.

Fragility fracture systems, Latin America perspective.

Osteoporosis is a worldwide epidemic, affecting an average of 30% to 50% of those over 50 years of age in Latin America. Resulting from it is another epidemic, that of fragility fractures, which adversely affects morbidity and mortality of this population. Increasing in their incidence, fragility fractures are expected to occur in 1 in 3 women and 1 in 5 men over 50years of age during their lifetimes. Currently, there are diagnostic and management guidelines for fragility fractures in Latin American countries, especially those for hip and spine fractures. In general, in Latin America, the quality indicators and standards for the care of these fractures vary greatly according to the health system, being suboptimal in many situations. The organization of health services is different in the different countries throughout Latin America. Common underlying characteristics, however, include the distinctions that exist in care between public and private medicine and the lack of economic resources directed to public healthcare systems from the national levels. Several important changes have been implemented in recent years, with the collaboration between national organizations and international associations such as the Fragility Fracture Network and the International Osteoporosis Foundation, aimed at improving quality standards in care and rates of morbidity and mortality in patients treated thorough fragility fracture programs. The underregistration in these programs and absence of formal national registries also contribute to a lack of recognition of the size, scope, and severity of the problem.

The fracture liaison service: its history, current state, how it works, and future directions.

Osteoporotic fractures often result in reduced function after healing, with associated pain, disability, loss of independence, and reduced quality of life. Following osteoporotic fractures, it is common for older adults to sustain subsequent, or secondary, fractures. These fractures include those of the proximal femur, vertebrae, distal radius, proximal humerus, and other sites. Although widely recognized as a gap in care, the implementation of appropriate secondary fracture prevention programs has been carried out in most countries. A Fracture Liaison Service represents the best secondary fracture prevention model of care for managing osteoporosis following fragility fractures and falls. These programs have proven to be cost-effective, and represent a major advancement in patient care over those "usual care practices" seen in most community and academic medical centers. Key Fracture Liaison Service programmatic functions include case finding, patient assessment, osteoporosis assessment, initiation of osteoporosis treatment, falls prevention, education, and exercise.

Clinical risk factor status in patients with vertebral fracture but normal bone mineral density.

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.

Impact of Socioeconomic Factors on Patient's Adherence to Lifestyle Modifications Aimed at Reducing Future Fracture Risk in Geriatric Patients With Peritrochanteric Fragility Fractures of the Hip.

Introduction A history of fracture is a well-documented risk factor for sustaining future falls and subsequent fractures in geriatric patients. Orthopedic surgeons advocate various lifestyle modifications to reduce the risk of sustaining a recurrent fracture in this vulnerable group. However, it has been observed that patients seldom adhere to this advice and the rate of fragility fractures has thus continued to rise in this vulnerable subset of the population. The factors influencing the compliance of patients with various modifications have not been documented in any previous studies. In our study, we aimed to evaluate the factors influencing patient adherence to various lifestyle modifications advised by orthopedic surgeons for reducing future fracture risk. Material and methods A total of 112 patients aged >65 years who were diagnosed as having a peritrochanteric fragility fracture of the hip and were treated operatively for the same were included in this study. Upon discharge from the hospital, the patients were advised 10 lifestyle modifications to reduce the recurrent fracture risk. A data collecting form that graded the adherence on a 20-point scale (2 points for each lifestyle modification) was prepared by the investigators. Upon the six-month follow-up visit, adherence was assessed on the 20-point scale, and data were collected via the face-to-face interview method. Statistical analysis was accomplished by the Chi-square test and logistic regression analysis. Observations and results Of the 112 subjects included in the study, 58 (51.7%) were male and the mean age was 75 ± 8 (65 - 92) years. The adherence to less than 4 recommendations (Score <8) was seen in 39.2%, adherence to 4 - 6 recommendations (Score between 8 - 12) was seen in 30.86%, adherence to 6 - 8 recommendations (Score between 12 and 16) was seen in 29.94% and adherence to eight to 10 recommendations (score between 16 and 20) was seen in 0% of participants. According to the regression analysis, the presence of adherence to less than six recommendations was related to the low-income level (OR=0.298; 95%CI - 0.132-0.666; p<0.001) and lack of education and awareness (OR=2.329; 95% CI - 1.114-4.859; p=0.002). Conclusion The rates of adherence to advised lifestyle modifications were generally found to be low. Compliance was particularly reduced in patients belonging to the lower socioeconomic strata, which were less likely to be educated and had lower rates of income. The authors concluded that merely advising lifestyle modifications was not enough, and various social and public health measures are required to improve patient compliance, with the broader aim of ending the menace of recurrent fragility fractures.

Incidence of fractures and clinical profile of patients following up at a Fracture Liaison Service in the city of Curitiba.

BACKGROUND: Osteoporotic fractures are common, and their incidence are increasing worldwide. The first fracture doubles the risk of new fractures. Despite that, up to 80% of patients with a fragility fracture are evaluated or treated to reduce the risk of new fractures. AIMS: To evaluate the results of the operation of the hospital Fracture Liaison Service (FLS) and to analyze the clinical characteristics of the patients attending the service in its first 2 years of operation and to estimate the fracture risk reduction ratio. METHODS: The FLS managed patients older than 50 years who were admitted with a low-energy trauma fracture between January 2017 and April 2018. This management consists in a full medical evaluation, nutritional and physical activity guidance, and specific osteoporosis treatment, if needed. RESULTS: We monitored and treated 135 patients. Forty percent of them had a previous fracture and only 20.3% of them received treatment to prevent new fractures. On Kaplan-Meier analysis, the estimated incidence of new fractures over 24 months was 12.1% (95% CI 7.2-20.8%), indicating that the percentage of patients without new fractures due to bone fragility during treatment was estimated at 87.9% (95% CI 79.2-92.8%). CONCLUSIONS: The evaluation and treatment of patients who sustained a fragility fracture to prevent a secondary fracture is effective in reducing the risk of new fractures in high-risk patients.

Enfoques terapéuticos de la osteoporosis / Therapeutic approaches to osteoporosis

La finalidad del tratamiento de la osteoporosis es la prevención primaria y secundaria de fracturas. Las indicaciones para las intervenciones terapéuticas en la osteoporosis deben derivarse de la determinación del riesgo absoluto de fractura, que tiene en cuenta la evaluación de los factores de riesgo y la densidad ósea. El propósito de este estudio es comentar algunos enfoques terapéuticos empleados en la osteoporosis, destacando el mecanismo de acción del ranelato de estroncio que aumenta la formación de hueso y disminuye la resorción. La causa más común de osteoporosis en las mujeres es la disminución de los niveles de estrógeno durante la menopausia, lo que lleva a un aumento significativo en el recambio de masa ósea y el consiguiente desequilibrio entre la formación y reabsorción ósea con un aumento de la pérdida ósea y el deterioro de la estructura y fuerza óseas. El ranelato de estroncio sigue siendo una opción farmacológica eficaz y viable en la prevención de las fracturas vertebrales y del cuello femoral en mujeres posmenopáusicas y hombres adultos con osteoporosis, en cuanto a indicaciones, contraindicaciones y una cuidadosa evaluación de sus efectos y riesgos. Representa una alternativa a los medicamentos antirresortivos en caso de contraindicación, intolerancia o fracaso(AU)

The purpose of the treatment of osteoporosis is the primary and secondary prevention of fractures. The indications for therapeutic interventions in osteoporosis should be derived from the determination of the absolute risk of fracture, which takes into account the evaluation of risk factors and bone density. To comment on some therapeutic approaches used in osteoporosis, highlighting the mechanism of action of strontium ranelate that increases bone formation and reduces resorption. The most common cause of osteoporosis in women is the decrease in estrogen levels during menopause, which leads to a significant increase in the turnover of bone mass and the consequent imbalance between bone formation and resorption with an increase in bone loss and deterioration of bone structure and strength. Strontium ranelate continues to be an effective and viable pharmacological option in the prevention of vertebral and femoral neck fractures in postmenopausal women and adult men with osteoporosis, in terms of indications, contraindications and a careful evaluation of its effects and risks. It represents an alternative to antiresorptive drugs in case of contraindication, intolerance or failure(AU)

Effect of coordinator-based osteoporosis intervention on quality of life in patients with fragility fractures: a prospective randomized trial.

We examined the effects of the coordinator-based intervention on quality of life (QOL) in the aftermath of a fragility fracture, as well as factors predictive of post-fracture QOL. The coordinator-based interventions mitigated the decrease in QOL. Secondary fracture after primary fracture, however, was a significant predictor of lower QOL. PURPOSE: This study aimed to determine the effects of the coordinator-based intervention on QOL in the aftermath of a fragility fracture, as well as factors predictive of post-fracture QOL, in an Asian population. METHODS: Patients with new fractures in the intervention group received the coordinator-based intervention by a designated nurse certified as a coordinator, within 3 months of injury. QOL was evaluated using the Japanese version of the EuroQol 5 Dimension 5 Level (EQ-5D-5L) scale  before the fracture (through patient recollections) and at 0.5, 1, and 2 years after the primary fracture. RESULTS: Data for 141 patients were analyzed: 70 in the liaison intervention (LI) group and 71 in the non-LI group. Significant intervention effects on QOL were observed at 6 months after the fracture; the QOL score was 0.079 points higher in the LI group than in the non-LI group (p=0.019). Further, the LI group reported significantly less pain/discomfort at 2 years after the fracture, compared to the non-LI group (p=0.037). In addition, secondary fractures were found to significantly prevent improvement and maintenance of QOL during the recovery period (p=0.015). CONCLUSION: Short-term intervention effects were observable 6 months after the primary fracture, with the LI group mitigated the decrease in QOL. Few patients in the LI group reported pain/discomfort 2 years after the fracture, but there is uncertainty regarding its clinical significance. Secondary fracture after initial injury was a significant predictor of lower QOL after a fracture.

Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience.

INTRODUCTION: Japan is a super-aging society, the geriatric care system establishment for hip fractures is at an urgent task. This report described our concept of multidisciplinary care model for geriatric hip fractures and 5-year outcomes at the Toyama City Hospital, Japan. METHODS: In this retrospective cohort study, a multidisciplinary treatment approach was applied for elderly patients with hip fracture since 2014. These patients (n = 678, males: n = 143, mean age: 84.6 ± 7.5 years), were treated per the multidisciplinary care model. Time to surgery, length of hospital stays, complications, osteoporosis treatment, mortality, and medical costs were evaluated. RESULTS: The mean time to surgery was 1.7 days. Overall, 78.0% patients underwent surgery within 2 days. The mean duration of hospital stay was 21.0 ± 12.4 days. The most frequent complication was deep venous thrombosis (19.0%) followed by dysuria (14.5%). Severe complications were pneumonia 3.4%, heart failure 0.8% and pulmonary embolism 0.4%. The in-hospital mortality rate was 1.2%. The 90-day, 6-month, and 1-year mortality rates were 2.5%, 6.7%, and 12.6%, respectively. The pharmacotherapy rate for osteoporosis at discharge was 90.7%, and the continuation pharmacotherapy rate was 84.7% at 1-year follow-up. The total hospitalization medical cost per person was lower than about 400 other hospitals' average costs every year, totaled 14% less during the 5-year study period. CONCLUSION: We have organized a multidisciplinary team approach for geriatric hip fracture. This approach resulted in a shorter time to surgery and hospital stay than the national average. The incidence of severe complications and mortality was low. The multidisciplinary treatment has maintained a high rate of osteoporosis treatment after discharge and at follow-up. Furthermore, the total medical cost per person was less than the national average. Thus, the multidisciplinary treatment approach for geriatric hip fractures was effective and feasible to conduct in Japan.

A multi-site review of second hip fractures across 6 Dublin teaching hospitals.

INTRODUCTION: Fragility hip fractures are common and costly. Secondary fracture prevention is a treatment goal following hip fracture; however, the number of those that proceed to fracture their contralateral hip in Ireland is unknown. There are plans to introduce a Fracture Liaison Service Database in Ireland which will aim to prevent secondary fractures. To establish a baseline figure for secondary hip fractures, the injury radiographs of 1284 patients from 6 teaching hospitals over a 1-year period were reviewed. METHODS: Irish Hip Fracture Datasheets and corresponding injury radiographs were reviewed locally for all hip fractures within each respective teaching hospital for a 1-year period (2019). RESULTS: A total of 8.7% of all fragility hip fractures across the 6 hospitals were secondary hip fractures (range 4.9-11.5%). 46% occurred within years 1 to 3 following index hip fracture. Forty-eight per cent of patients were started on bone protection medications following their second hip fracture. DISCUSSION/CONCLUSION: Approximately 1 in 11 hip fractures treated across the 6 teaching hospitals assessed in 2019 was a patient's second hip fracture. We advocate for the widespread availability of Fracture Liaison Services to patients throughout Ireland to assist secondary fracture prevention.

Cost-effectiveness of secondary fracture prevention intervention for Medicare beneficiaries.

BACKGROUND: Secondary fracture prevention intervention such as fracture liaison services are effective for increasing osteoporosis treatment rates, but are not currently widely used in the United States. We evaluated the cost-effectiveness of secondary fracture prevention intervention after osteoporotic fracture for Medicare beneficiaries. METHODS: An individual-level state-transition microsimulation model was developed to evaluate the cost-effectiveness of secondary fracture prevention intervention compared with usual care for U.S. Medicare patients aged 65 and older who experience a new osteoporotic fracture. Patients who initiated pharmacotherapy and remained adherent were assumed to be treated for 5 years. Outcome measures included subsequent fractures, average lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios in 2020 U.S. dollars per QALY gained. The model time horizon was lifetime, and analysis perspective was payer. RESULTS: Base-case analysis results showed that the secondary fracture prevention intervention strategy was both more effective and less expensive than usual care-thus, it was cost-saving. Model findings indicated that the intervention would reduce the number of expected fractures by approximately 5% over a 5-year period, preventing approximately 30,000 fractures for 1 million patients. Secondary fracture prevention intervention resulted in an average cost savings of $418 and an increase in QALYs of 0.0299 per patient over the lifetime; for 1 million patients who receive the intervention instead of usual care, expected cost savings for Medicare would be $418 million dollars. One-way and probabilistic sensitivity analyses supported base-case findings of cost savings. CONCLUSION: Secondary fracture prevention intervention for Medicare beneficiaries after a new osteoporotic fracture is very likely to both improve health outcomes and reduce healthcare costs compared with usual care. Expansion of its use for this population is strongly recommended.