Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study

Fraser, Lisa-Ann; Ioannidis, George; Adachi, Jonathan D.; Pickard, Laura; Kaiser, Stéphanie; Prior, Jerilynn C.; Brown, J. P.; Hanley, David A.; Olszynski, Wojciech P.; Anastassiades, Tassos; Jamal, Sophie A.; Josse, Robert G.; Goltzman, David; Παπαϊωάννου, Αλεξάνδρα

doi:10.1007/s00198-010-1359-2

Cited by 47 publications

(28 citation statements)

References 42 publications

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“…Of greatest clinical concern is the loss of independence and mortality risk following hip fracture and low treatment rates. Our findings are consistent with prior estimates [1, 31–34] and emphasize the urgent need to better manage osteoporosis and develop targeted interventions to reduce hip fracture risk. We found that only 10 % (men) to 32 % (women) of patients filled an osteoporosis treatment prior to fracture, and this increased only to 22 % of men and 44 % of women within the year after hip fracture.…”

Section: Discussionsupporting

confidence: 91%

Direct health-care costs attributed to hip fractures among seniors: a matched cohort study

et al. 2012

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SummaryUsing a matched cohort design, we estimated the mean direct attributable cost in the first year after hip fracture in Ontario to be $36,929 among women and $39,479 among men. These estimates translate into an annual $282 million in direct attributable health-care costs in Ontario and $1.1 billion in Canada.IntroductionOsteoporosis is a major public health concern that results in substantial fracture-related morbidity and mortality. It is well established that hip fractures are the most devastating consequence of osteoporosis, yet the health-care costs attributed to hip fractures in Canada have not been thoroughly evaluated.MethodsWe determined the 1- and 2-year direct attributable costs and cost drivers associated with hip fractures among seniors in comparison to a matched non-hip fracture cohort using health-care administrative data from Ontario (2004–2008). Entry into long-term care and deaths attributable to hip fracture were also determined.ResultsWe successfully matched 22,418 female (mean age = 83.3 years) and 7,611 male (mean age = 81.3 years) hip fracture patients. The mean attributable cost in the first year after fracture was $36,929 (95 % CI $36,380–37,466) among women and $39,479 (95 % CI $38,311–$40,677) among men. These estimates translate into an annual $282 million in direct attributable health-care costs in Ontario and $1.1 billion in Canada. Primary cost drivers were acute and post-acute institutional care. Approximately 24 % of women and 19 % of men living in the community at the time of fracture entered a long-term care facility, and 22 % of women and 33 % of men died within the first year following hip fracture. Attributable costs remained elevated into the second year ($9,017 among women, $10,347 among men) for patients who survived the first year.ConclusionsWe identified significant health-care costs, entry into long-term care, and mortality attributed to hip fractures. Results may inform health economic analyses and policy decision-making in Canada.

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Section: Discussionsupporting

confidence: 91%

Direct health-care costs attributed to hip fractures among seniors: a matched cohort study

et al. 2012

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“…Approximately 20 to 30 % of fragility fractures are properly managed worldwide, with a ratio of treatment considerably lower than that [1, 12, 28–30]. Our overall management ratio was of 58 % when patients were referred to the MDTU, which demonstrates an important increase in management rate.…”

Section: Discussionmentioning

confidence: 82%

The impact of a standardized order set for the management of non-hip fragility fractures in a Fracture Liaison Service

Senay

Delisle

Giroux³

et al. 2016

Osteoporos Int

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SummaryWe analysed the impact of a standardized order set empowering staff nurses to independently manage a Fracture Liaison Service over a 9-month period. Nurses identified between 30 and 70 % of non-hip fragility fractures to the unit in charge of management over time. The latter managed 58 % of referred patients.IntroductionThe main goal of this study was to evaluate the impact of a standardized order set empowering nurses to independently manage a fracture liaison service (FLS).MethodsSince November 2014, an order set allowed nurses of a Montreal hospital, Quebec, Canada to entirely manage an FLS on their own. Nurses followed an 6-h training program on-site. Emergency department (ED) and orthopaedic outpatient clinic (OC) nurses identified non-hip fragility fractures. Medical day treatment unit (MDTU) nurses were in charge of the management (investigation and treatment initiation). The list of patients, 50 years and older, with a fracture were retrieved for the period of November 2014 to July 2015. Performance was assessed with the rate of identification over time and the rate of management of non-hip fragility fractures.ResultsOver the 9-month period, 346 patients of ≥50 years old were seen for a fracture, of which 190 met fragility criteria (excluding hip fractures). A sinusoid pattern of rates of identification between 30-70 % was observed over time. An average proportion of 58.1 % of fracture patients were managed by MDTU nurses.ConclusionsA standardized order set legally allowing nurses to manage an FLS led to identification rates varying from 30–70 % and a management rate close to 60 % for referred patients over a 9-month period, which largely exceeds that of standard care. Identification was mostly compromised by difficulty integrating the order set into routine practice. Enforcement of the hospital policy on fragility fractures could help yield efficiency of identification of osteoporosis-related fractures by the staff.

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“…As recently pointed out [26], the search for newer therapeutics for osteoporosis continues because: (i) None of the available drug classes eliminates the risk of fragility fractures, (ii) the side effects of all classes remain a major concern as we also noted [24,25], and that (iii) no one drug restores the micro architectural deterioration caused by this disease. We discovered GlcNBu to be safe in very high doses in animal studies (unpublished), and we have also observed no toxicity with high concentrations in vitro [4,5], although formal toxicology has not been conducted.…”

Section: Discussionmentioning

confidence: 96%

“…In the same study, we found a very sizeable osteoporosis "care gap". Annual data collection over a 10-year period of this multicenter study showed that 42-56% of women [24] and approximately 90% of men [25] with a clinical fragility fracture were not treated with an osteoporosis medication.…”

Section: Discussionmentioning

confidence: 99%

The modified amino sugar N-Butyryl Glucosamine fed to ovariectomized rats preserves bone mineral through increased early mineralization, but does not affect body composition

Anastassiades

Rees-Milton²,

Hopman³

2017

FFHD

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Citation: Anastassiades T., Ress-Milton K., Hopman W.M., The modified amino sugar NButyryl Glucosamine fed to ovariectomized rats preserves bone mineral through increased early mineralization, but does not affect body composition. Functional Foods in Health and Disease 2017; 7(10): 795-815 ABSTRACT Background: The toxicities of pharmaceuticals for chronic arthritis and osteoporosis should be of concern to consumers. This partially accounts for the popularity of consumption of the amino sugar glucosamine, in-spite of controversy about its efficacy. We chemically synthesized Nbutyryl glucosamine (GlcNBu), which we discovered protected bone and cartilage in an inflammatory arthritis rat model when used as a feed supplement. GlcNBu can also be potentially synthesized biochemically, since we recently demonstrated that human acetyl-CoA: glucosamine-6-phosphate N-acetyltransferase 1 has a relaxed donor specificity and transfers acyl groups of up to four carbons in length, i.e. the butyryl moiety. Oral GlcNBu had no detectable toxicity and also protected against bone loss in ovariectomized (OVX) rats as a model for osteoporosis. However, we demonstrated this only for bones excised at 6 months. Thus, the current study aims to determine when bone mineralization is maximized during daily GlcNBu supplementation, in both OVΧ and Sham-OVX rats, in addition to the relationship of bone mineralization to body composition.Methods: Female Sprague-Dawley rats were randomized into 4 groups, containing 8 rats each. The groups consisted of OVX or Sham-OVX rats whose diets were supplemented with either 200 mg/kg/day of GlcNBu or an equimolar amount of glucose. We performed sequential bone density and body composition measurements, by dual-energy X-ray absorptiometry in the live, anesthetised rats, over a 6-month experimental period, starting at the age of 8 weeks. Results were analyzed by descriptive statistics and 2-way ANOVA. Results:The major increases in the mineral content and density of the spine and the femur in GlcNBu-supplemented rats occurred early, from the baseline to week 8. Ovariectomy resulted in a number of significant differences in body composition, while feeding GlcNBu had no significant effects on body composition. The significant effects of ovariectomy on body composition initially appeared at 8 weeks, while the GlcNBu effects on increased bone mineral initially appeared at 2 weeks. An interaction between OVX and GlcNBu was seen only at 16 weeks for the bone mineral density of the femoral head.Conclusions: Supplementation of the diet by GlcNBu in both OVX and Sham-OVX rats increases bone mineral as early as 2 weeks. Ovariectomy but not GlcNBu supplementation had a significant effect on body composition. The effect of GlcNBu occurs independently of changes in body composition, probably as a direct effect of stimulation of bone matrix synthesis which continues to be mineralized. This work represents an important step in the development and commercialization of GlcNBu for the prevention and treatment osteoporosis, wh...

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Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study

Abstract: In a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures. Although bisphosphonate therapy usage improved over time, a substantial gap remains.

Cited by 47 publications

References 42 publications

Direct health-care costs attributed to hip fractures among seniors: a matched cohort study

Direct health-care costs attributed to hip fractures among seniors: a matched cohort study

The impact of a standardized order set for the management of non-hip fragility fractures in a Fracture Liaison Service

The modified amino sugar N-Butyryl Glucosamine fed to ovariectomized rats preserves bone mineral through increased early mineralization, but does not affect body composition

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