A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving

Leslie, William D.; Giangregorio, Lora; Yogendran, Marina; Azimaee, Mahmoud; Morin, Suzanne N; Metge, Colleen; Caetano, Patrícia; Lix, Lisa M.

doi:10.1007/s00198-011-1630-1

Cited by 129 publications

(92 citation statements)

References 41 publications

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“…Osteoporotic fractures are a major contributor to late life morbidity and mortality and impose a substantial societal cost. Despite the availability of treatments of proven efficacy, there is room for improving the treatment rates at the time of and after major fragility fractures [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

et al. 2015

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Objectives Opportunistic screening for osteoporosis using computed tomography (CT) examinations that happen to visualise the spine can be used to identify patients with osteoporosis. We sought to verify the diagnostic performance of vertebral Hounsfield unit (HU) measurements on routine CT examinations for diagnosing osteoporosis in a separate, external population. Methods Consecutive patients who underwent a CT examination of the chest or abdomen and had also received a dualenergy X-ray absorptiometry (DXA) test were retrospectively included. CTs were evaluated for vertebral fractures and vertebral attenuation (density) values were measured. Diagnostic performance measures and the area under the receiver operator characteristics curve (AUC) for diagnosing osteoporosis were calculated. Results Three hundred and two patients with a mean age of 57.9 years were included, of which 82 (27 %) had osteoporosis according to DXA and 65 (22 %) had vertebral fractures.The diagnostic performance for vertebral HU measurements was modest, with a maximal AUC of 0.74 (0.68 -0.80). At that optimal threshold the sensitivity was 62 % (51 -72 %) and the specificity was 79 % (74 -84 %). Conclusions We confirmed that simple trabecular vertebral density measurements on routine CT contain diagnostic information related to bone mineral density as measured by DXA, albeit with substantially lower diagnostic accuracy than previously reported. Key Points • We externally validated the value of vertebral trabecular bone attenuation for osteoporosis • These diagnostic performance measures were, however, substantially lower than previously reported • This information might be useful when considering the implementation of opportunistic osteoporosis screening

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Section: Introductionmentioning

confidence: 99%

Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

et al. 2015

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“…1 Most of the people who have had a major osteoporotic fracture (more than 80% in a recent Manitoba study) do not undergo testing for bone mineral density or pharmacologic treatment to assist in preventing further fractures. 2,3 This gap in care is a missed opportunity for secondary prevention, because people who have already sustained a fragility fracture are at much higher risk for recurrent fractures. 4 Educational initiatives are necessary but are insufficient for effecting a system-wide improvement in care.…”

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confidence: 99%

Closing the gap in postfracture care at the population level: a randomized controlled trial

Leslie

LaBine

Klassen

et al. 2011

CMAJ

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“…Though orthopaedic surgeons are willing and interested in being an integral part of the diagnosis and initial treatment of patients with decreased BMD, previous studies have demonstrated that the gap in the treatment of osteoporotic individuals occurs between the orthopaedist and the patient's primary care provider [33,55,56]. In an effort to rectify this situation, the FLS has been proposed to function as the clearing house and manager for a patient's BMD work up and treatment [34,57].…”

Section: What Happens To Patients That I Refer For Evaluation?mentioning

confidence: 99%

Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients’ bone health

Farmer

Herbert

Cuellar

et al. 2014

International Orthopaedics (SICOT)

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Osteoporosis has been recognised as a public health concern for at least three decades but it has been relatively recent that the push has been for orthopaedic surgeons to take a more active role in the diagnosis and treatment of patients with decreased bone mineral density (BMD). Most often these patients are encountered after they have suffered a fracture making secondary prevention the area where orthopaedists may exert the greatest influence on patient care. The purpose of this article is to provide a succinct framework for the diagnosis and treatment of patients with decreased BMD. Patients are deemed to have decreased BMD if they have suffered a fragility fracture, a fracture caused by a lowenergy traumatic event. These patients are often encountered in the emergency department and admitted for further treatment of their fractures or recommended for follow-up in the clinic. Regardless of treatment course these are opportunities for the orthopaedic surgeon to intervene in the osteoporotic disease process and positively affect a patient's bone health. This article compiles the available literature on osteoporosis and presents it succinctly with the incorporation of both a diagnosis algorithm and treatment profile table. With the use of these two tools, orthopaedic surgeons everywhere should be able to take a more active role in their patients' bone health.

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A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving

Cited by 129 publications

References 41 publications

Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

Closing the gap in postfracture care at the population level: a randomized controlled trial

Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients’ bone health

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