Experience of a systematic approach to care and prevention of fragility fractures in New Zealand

Gill, Christine Ellen; Mitchell, P. J.; Clark, Jan Guynes; Cornish, Jillian; Fergusson, Peter; Gilchrist, Nigel; Hayman, Lynne M.; Hornblow, Sue; Kim, David; Mackenzie, Denise; Milsom, Stella R.; Tunzelmann, Adrienne von; Binns, Elizabeth; Fergusson, Kim; Fleming, Stewart; Hurring, Sarah; Lilley, Rebbecca; Miller, Caroline; Navarre, Pierre; Pettett, Andrea; Sankaran, Shankar; Seow, Min Yee; Sincock, Jenny; Ward, Nicola; Wright, Mark; Close, Jacqueline Clare Therese; Harris, Ian; Armstrong, Elizabeth; Hallen, Jamie; Hikaka, Joanna; Kerse, Ngaire; Vujnovich, Andrea; Ganda, Kirtan; Seibel, Markus J.; Jackson, Thomas J.; Kennedy, Paul; Malpas, Kirsten; Dann, Leona; Shuker, Carl; Dunne, Colleen; Wood, Philip A.; Magaziner, Jay; Marsh, David; Tabu, Irewin A.; Cooper, Cyrus; Halbout, Philippe; Javaid, Muhammad Kassim; Åkesson, Kristina; Mlotek, Anastasia Soulié; Brûlé-Champagne, Eric; Harris, Roger

doi:10.1007/s11657-022-01138-1

Cited by 7 publications

(8 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study demonstrates that despite standardized hip fracture programs at many treating hospitals (44%) and the frequent co-management of patients by non-surgical medical teams (94%), the majority of patients (74%) were not prescribed anti-osteoporosis medications following hip fracture surgery, and male patients had lower odds of receiving prescriptions. These findings are consistent with those in an analysis of post-fragility fracture care using the Australian and New Zealand Hip Fracture Registry, where despite widespread implementation of Orthogeriatric co-management programmes during hospitalization, prescription of secondary prevention medication was inconsistent and remained low [52]. These findings and combined with those in our study suggest that in-patient optimization of hip fracture care alone may not be sufficient to ensure adequate post-admission treatment of osteoporosis.…”

Section: Plos Onesupporting

confidence: 90%

Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort

et al. 2022

View full text Add to dashboard Cite

Background Initiation of anti-osteoporosis medications after hip fracture lowers the risk of subsequent fragility fractures. Historical biases of targeting secondary fracture prevention towards certain groups may result in treatment disparities. We examined associations of patient age, sex and race with anti-osteoporosis medication prescription following hip fracture. Methods A cohort of patients with a hip fracture between 2016–2018 was assembled from the American College of Surgeons National Surgical Quality Improvement Program registry. Patients on anti-osteoporosis medications prior to admission were excluded. Multivariable logistic regression was used to determine adjusted associations between patient age, sex and race and their interactions with prescription of anti-osteoporosis medications within 30 days of surgery. Results In total, 12,249 patients with a hip fracture were identified with a median age of 82 years (IQR: 73–87), and 67% were female (n = 8,218). Thirty days postoperatively, 26% (n = 3146) of patients had been prescribed anti-osteoporosis medication. A significant interaction between age and sex with medication prescription was observed (p = 0.04). Male patients in their 50s (OR:0.75, 95%CI:0.60–0.92), 60s (OR:0.81, 95%CI:0.70–0.94) and 70s (OR:0.89, 95%CI:0.81–0.97) were less likely to be prescribed anti-osteoporosis medication compared to female patients of the same age. Patients who belonged to minority racial groups were not less likely to receive anti-osteoporosis medications than patients of white race. Interpretation Only 26% of patients were prescribed anti-osteoporosis medications following hip fracture, despite consensus guidelines urging early initiation of secondary prevention treatments. Given that prescription varied by age and sex, strategies to prevent disparities in secondary fracture prevention are warranted.

show abstract

Section: Plos Onesupporting

confidence: 90%

Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Furthermore, as national registries grow in number and size with time, they will allow to perform interesting analyses with comparisons between countries. These initiatives are also crucial to monitor the effectiveness of the existing model of care, promoting its continuous improvement, and to increase awareness among policymakers and health professionals [ 40 , 41 ]. Collaborative efforts aimed at sharing experiences of existing national registries and providing guidance to upcoming registries such as the “The Hip Fracture Registry Toolbox” are much appreciated [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards

et al. 2022

View full text Add to dashboard Cite

Summary REFRA-FLS is a new registry in Spain aimed at identifying individuals over 50 years of age with a fragility fracture. Using this registry, we found hip fracture is the most prevalent fracture. Treatment for osteoporosis was 87.7%, with 65.3% adherence. REFRA-FLS provides fundamental data in the study of fragility fractures. Purpose Fragility fractures are a growing public health concern in modern-aged societies. Fracture Liaison Services (FLS) have been shown to successfully lower rates of secondary fractures. A new registry (REFRA-FLS) has been created to monitor quality indicators of FLS units in Spain and to explore the occurrence and characteristic of fragility fractures identified by these centers. Methods We conducted a prospective cohort study based on fragility fractures recorded in the REFRA-FLS registry. Participants were individuals 50 years or above who suffered a low energy fragility fracture identified by the 10 participating FLS units during the study period. The type of FLS unit, the characteristics of the individuals at baseline, along with patient outcomes as quality indicators among those who completed 1 year of follow-up were analyzed. Results A total of 2965 patients and 3067 fragility fractures were identified, and the most frequent locations were hip (n = 1709, 55.7%) and spine (n = 492, 16.0%). A total of 43 refractures (4.5%) and 46 deaths (4.9%) were observed among 948 individuals in the follow-up analyses. Time from fracture to evaluation was less than 3 months in 76.7% of individuals. Osteoporosis treatment was prescribed in 87.7%, and adherence was 65.3% in Morisky–Green test. Conclusion Our results provide a comprehensive picture of fragility fractures identified in FLS units from Spain. Overall, quality indicators are satisfactory although a much higher use of DXA would be desirable. As the registry grows with the incorporation of new FLS units and longer follow-up, incoming analyses will provide valuable insight.

show abstract

“…Encouraging healthcare personnel to have open communication has been a focus and priority in selected national PFCP. In New Zealand, communication between the tertiary and primary care providers for every hip fracture patient at the time of hospital discharge is 1 of 7 principal quality measures in the program 10 . Furthermore, New Zealand conducts an annual Hip Fest, where a wide variety of healthcare professionals and hospital executives share best practices and learn new management strategies and paradigms.…”

Section: Barriers and Challenges For Multidisciplinary Pfcpmentioning

confidence: 99%

Team Approach: Organizing and Empowering Multidisciplinary Teams in Postfragility Fracture Care

Becerril,

Dirschl

2023

JBJS Reviews

View full text Add to dashboard Cite

» Numerous healthcare roles can be valuable and effective participants in postfracture care programs (PFCPs) and can also serve effectively as program liaisons/champions.» Greatest success seems to have been achieved when a single entity provides cohesive and consistent training, coordination, shared goals, and accountability for program sites and site leaders.» Few PFCPs have solved what seems to be the fundamental challenge of such programs: how to maintain program effectiveness and cohesion when the patient makes the inevitable transition from acute care to primary care? Creating a partnership with shared goals with primary care providers is a challenge for every program in every location.» Programs located in the United States, with its predominantly “open” healthcare system, seem to lag other parts of the world in overcoming this fundamental challenge.» It is hoped that all PFCPs in all systems can learn from the successes of other programs in managing this critical transition from acute to primary care.

show abstract

Experience of a systematic approach to care and prevention of fragility fractures in New Zealand

Cited by 7 publications

References 13 publications

Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort

Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort

Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards

Team Approach: Organizing and Empowering Multidisciplinary Teams in Postfragility Fracture Care

Contact Info

Product

Resources

About