Improvement in the primary and secondary prevention of osteoporosis by a Fracture Liaison Service: feedback from a single French center care pathway

Vrignaud, Arthur; Pelletier, Simon; Dernis, Emmanuelle; Moui, Yvon; Haettich, B.

doi:10.1007/s11657-018-0523-8

Cited by 11 publications

(18 citation statements)

References 25 publications

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“…A prominent strategy to address this crisis has been the widespread adoption of FLS programs, which have proved effective in improving rates of osteoporosis management and reducing rates of secondary fragility fractures in certain studies 34 - 38 . However, such initiatives are not universally associated with improved outcomes 39 , 40 .…”

Section: Discussionmentioning

confidence: 99%

Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures

et al. 2021

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Background: Fragility fractures are often sentinel events in documenting new cases of osteoporosis. Numerous analyses have demonstrated low rates of adequate osteoporosis evaluation and treatment following primary fragility fractures. The purpose of this study was to quantify the incidence of primary fragility fractures in America and the rates of osteoporosis screening and management before and after fracture. Methods: A retrospective review of the PearlDiver database was conducted using the International Classification of Diseases, Ninth Revision (ICD-9) and ICD, Tenth Revision (ICD-10) and Current Procedural Terminology codes. Patients who were 60 to 80 years of age and had primary fragility fractures of the hip, wrist, spine, pelvis, humerus, and other unspecified locations were included. The rates of dual x-ray absorptiometry (DXA) screening and osteoporosis pharmacotherapy were assessed for 2 years before and 2 years after the primary fracture. Results: In this study, 48,668 patients with a primary fragility fracture were identified. Within this cohort, 25.8% (12,573 of 48,668) had received osteoporosis screening or treatment in the prior 2 years. In the 36,095 patients with no management before the fracture, 19% (6,799 patients) were diagnosed with osteoporosis and 18.4% (6,653 patients) received a DXA scan and/or filed claims for pharmacotherapy in the following 2 years. Patients with an osteoporosis diagnosis were more likely to receive both types of management (odds ratio [OR], 11.55 [95% confidence (CI), 10.31 to 12.95]), and male patients were less likely to receive both types of management (OR, 0.23 [95% CI, 0.17 to 0.27]). Secondary fragility fractures within the next 2 years were diagnosed in 8.4% (3,038 of 36,095) of patients at a mean of 221 days following the primary fracture. Conclusions: The rates of appropriate osteoporosis evaluation, diagnosis, and management following primary fragility fractures remain unacceptably low. Less than one-third of patients with primary fragility fractures had been evaluated or treated for osteoporosis in the 2 years prior to fracture. Furthermore, among patients without pre-fracture management, <20% received osteoporosis screening or treatment within the next 2 years. Level of Evidence: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures

et al. 2021

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“…New models of care such as Fracture Liaison Services (FLS) or interventions based on a central coordinator, directed to the healthcare providers, patients or both, have been proposed to ensure the continuity of care, from the fracture care to the management of the underlying OP [15–17, 34]. Such models, aimed at increasing awareness and changing the behaviors of clinicians and/or patients, showed significant efficacy to improve OP care.…”

Section: Discussionmentioning

confidence: 99%

“…The reasons are probably multifactorial and related to the patient, but also to the healthcare system. Concerning OP management in France, different clinical trials have demonstrated that improvement is possible [3, 14–17]. Qualitative research is needed to understand how GPs deal with OP and why current evidence on OP management are not integrated in everyday practices [18].…”

Section: Introductionmentioning

confidence: 99%

Osteoporosis prevention: Where are the barriers to improvement in French general practitioners? A qualitative study

et al. 2019

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Background Osteoporosis prevention, diagnosis and treatment remain suboptimal. Objectives We conducted a qualitative study to understand barriers towards care initiation and levers to improve awareness and management of osteoporosis among general practitioners (GPs). Methods Semi-structured face-to face interviews were conducted with 16 GPs in the Rhône area of France to explore their knowledge and representations regarding osteoporosis. A thematic analysis of transcripts was performed to identify GPs’ perceptions on osteoporosis diagnosis, prevention, treatment and patients’ expectations. Results Interviewed GPs considered osteoporosis far less important than other chronic diseases. They questioned whether osteoporosis was a disease or normal aspect of ageing. They associated osteoporosis with fragility fractures, female sex, menopause, and old age but rarely with male sex. They regarded bone mineral density as the reference diagnostic test, but certain GPs indicated that they had difficulties to interpret the results and to know when to prescribe. Biphosphonates were mentioned as the reference treatment but some GPs expressed distrust about osteoporosis medications. Most of them did not think to screen for osteoporosis risk factors in their patients in a preventive medical approach. They mentioned the lack of time to implement prevention and were expecting clear and pragmatic guidelines, as well as information campaigns in general population to increase awareness on osteoporosis. Conclusion GPs tended to underestimate the salience of osteoporosis. Clear recommendations, better awareness of GPs and the general population could improve osteoporosis prevention and treatment.

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“…Proposed interventions included multimodal educational programs (hospital-or home-based, also via phone calls or patient literature) [222][223][224], early participation with decision-making, consideration of personal preferences [225], and occupational therapy [226]. Educational programs most frequently focused on the prevention of thromboembolism [227,228], adequate nutrition [229], physical exercise [230,231], and bone-protective therapy [232][233][234]. Overall, these interventions led to a more positive effect on patients' perceived participation in their rehabilitation and activities of daily living (ADL) at discharge [226].…”

Section: Post-acute Rehabilitative Programsmentioning

confidence: 99%

“…Moreover, they reduced the length of hospital stay, made home-discharge more likely, and reduced post-operative complications [126,235]. Programs of communication between patients and healthcare professionals via Fracture Liaison Services were shown to be beneficial in terms of primary and secondary fracture prevention [232].…”

Section: Post-acute Rehabilitative Programsmentioning

confidence: 99%

Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

Vincentis

Behr²,

Bellelli

et al. 2021

Aging Clin Exp Res

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Background Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. Aim To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. Methods A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra-and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. Results A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). Conclusion These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.

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Improvement in the primary and secondary prevention of osteoporosis by a Fracture Liaison Service: feedback from a single French center care pathway

Cited by 11 publications

References 25 publications

Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures

Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures

Osteoporosis prevention: Where are the barriers to improvement in French general practitioners? A qualitative study

Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

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