Adherence to fracture liaison service programs in patients over 70: the hidden part of the iceberg

Mugnier, Bénédicte; Daumas, Aurélie; Doddoli, Suchitra; Belmeliani, S.; Couderc, Anne-Laure; Mizzi, Barbara; Lévêque, Pierre; Villani, Patrick

doi:10.1007/s00198-020-05290-7

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…26 Another study in Australia indicated that 74% of FLS recipients had adhered to bisphosphonate therapy at 1 year, 27 which is comparable with the 1-year adherence rate among patients included in OWFLS in our study (73.5%). Remarkably, a study of FLS in France reported a 1-year adherence rate of less than 50% among patients aged 70 years or older; 28 this may be owing to differences in study design. The 3-year adherence rate in an observational study of patients who did not receive FLS was 25%, 25 which is comparable to the rate in our study (26%).…”

Section: Discussionmentioning

confidence: 96%

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

Cai,

Ying,

Zhang

et al. 2024

J Int Med Res

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Objective We established an orthopedic ward fracture liaison services (OWFLS) model and evaluated its role in improving detection rates of bone metabolic markers, treatment rates, and long-term treatability. Methods This observational retrospective cohort study included 120 patients aged >50 years hospitalized for primary osteoporotic fracture from January 2018 to January 2019 (group A: not included in OWFLS). Group B (included in OWFLS) comprised 120 patients from February 2019 to February 2020. We compared rates of bone metabolic index testing, treatment, and adherence; symptomatic improvement; and recurrent fracture between groups. Results Rates of bone metabolism index testing (50% vs. 0%) and medication use (94.2% vs. 64.2%) were significantly higher after OWFLS implementation. There was no significant difference in adherence rates at 3 months between groups (97.3% vs. 93.5%). Adherence rates at 1 and 3 years were better in group B than A (73.5% vs. 51.9%; 57.5% vs. 26%, respectively). Recurrence of bone pain at 1 and 3 years was significantly lower in group B than A (20.4% vs. 46.8%; 45.1% vs. 76.6%, respectively). Conclusions OWFLS improved the detection rate of bone metabolism indicators, treatment rate, and patient adherence and reduced recurrence of bone pain. OWFLS may be suitable for settings lacking human resources.

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Section: Discussionmentioning

confidence: 96%

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

Cai,

Ying,

Zhang

et al. 2024

J Int Med Res

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“…Over 70% of patients in the FLS-CP were on complete anti-fracture therapy 3 months later the post-surgical visit, and 80% persisted on treatments over the follow-up up to 1 year. In this context, it is conceivable that a higher rate of drug prescription or initiation of treatments close to the index event may increase medication adherence and persistence [ 33 , 35 ]. We argue that interdisciplinary management might have been crucial to overcoming previous results showing that almost half of hip-fracture patients receive anti-osteoporosis drug prescriptions within 3 months from hip fracture repair, and 39% assured 1-year drug adherence [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

The interdisciplinary fracture liaison service improves health-related outcomes and survival of older adults after hip fracture surgical repair

et al. 2022

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Summary 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.

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“…However, results from other FLS experiences were less optimistic. The FLS Database of the Royal College of Physicians reported a mean adherence at 12 months of 23% (range, 7–73% between FLS) 15 , and a French FLS found that less than half of patients adhered to the 1-year follow-up course and that this was strongly associated with adherence to treatment 16 . In the same way, a Spanish FLS reported adherence of 35% to oral bisphosphonates at 12 months in patients with hip fracture 17 .…”

Section: Discussionmentioning

confidence: 99%

Long-term persistence of treatment after hip fracture in a fracture liaison service

Naranjo

Molina

Quevedo

et al. 2022

Sci Rep

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Long-term adherence to antiosteoporosis medication (AOM) in the setting of a fracture liaison service (FLS) are not well known. Patients ≥ 50 with hip fracture seen in an FLS and recommended for treatment to prevent new fractures were analyzed. Baseline data included demographics, identification mode, previous treatment and FRAX items. Patient records were reviewed 3–8 years later, and these data were collected: (1) survival; (2) major refracture; (3) initiation of treatment, proportion of days covered (PDC) and persistence with AOM. 372 patients (mean age, 79 years; 76% women) were included. Mean follow-up was 47 months, 52 patients (14%) had a refracture (22 hip) and 129 (34.5%) died. AOM was started in 283 patients (76.0%). Factors associated with initiation of AOM were previous use of bisphosphonate (OR 9.94; 95% CI 1.29–76.32) and a lower T-score lumbar (OR 0.80; 95% CI 0.65–0.99). Persistence decreased to 72.6%, 60% and 47% at 12, 36 and 60 months. A PDC > 80% was confirmed in 208 patients (55.7%) and associated with previous use of bisphosphonate (OR 3.38; 95% CI 1.34–8.53), treatment with denosumab (OR 2.69; 95% CI:1.37–5.27), and inpatient identification (OR 2.26; 95% CI 1.18–4.34). Long-term persistence with AOM was optimal in patients with hip fracture seen at an FLS. A PDC > 80% was associated with inpatient identification and prescription of denosumab.

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Adherence to fracture liaison service programs in patients over 70: the hidden part of the iceberg

Cited by 8 publications

References 27 publications

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

The interdisciplinary fracture liaison service improves health-related outcomes and survival of older adults after hip fracture surgical repair

Long-term persistence of treatment after hip fracture in a fracture liaison service

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