Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England

Judge, Andrew; Javaid, Muhammad Kassim; Leal, José; Hawley, Samuel; Drew, Sarah; Heard, Shelley; Alhambra, D Prieto; Gooberman-Hill, Rachael; Lippett, Janet; Farmer, Andrew; Arden, N K; Gray, Alastair; Goldacre, M J; Delmestri, Antonella; Cooper, Cyrus

doi:10.3310/hsdr04280

Cited by 43 publications

(72 citation statements)

References 120 publications

(258 reference statements)

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“…For patients who experience OPrelated fractures, a cost burden is also placed on primary care. A study of UK databases reported that primary care costs increased significantly in the first 2 years after hip fracture [8]. Coordinator-based fracture liaison services for secondary prevention also usually require the GP's involvement as part of a multi-disciplinary team for treating patients and monitoring their progress [9,10].…”

Section: Introductionmentioning

confidence: 99%

The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

McCloskey

Rathi²,

Heijmans³

et al. 2020

Osteoporos Int

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This study in 8 countries across Europe found that about 75% of elderly women seen in primary care who were at high risk of osteoporosis-related fractures were not receiving appropriate medication. Lack of osteoporosis diagnosis appeared to be an important contributing factor. Introduction Treatment rates in osteoporosis are documented to be low. We wished to assess the osteoporosis treatment gap in women ≥ 70 years in routine primary care across Europe. Methods This cross-sectional observational study in 8 European countries collected data from women 70 years or older visiting their general practitioner. The primary outcome was treatment gap: the proportion who were not receiving any osteoporosis medication among those at increased risk of fragility fracture (using history of fracture, 10-year probability of fracture above country-specific Fracture Risk Assessment Tool [FRAX] thresholds, T-score ≤ − 2.5). Results Median 10-year probability of fracture (without bone mineral density [BMD]) for the 3798 enrolled patients was 7.2% (hip) and 16.6% (major osteoporotic). Overall, 2077 women (55%) met one or more definitions for increased risk of fragility fracture: 1200 had a prior fracture, 1814 exceeded the FRAX threshold, and 318 had a T-score ≤ − 2.5 (only 944 received a dualenergy x-ray absorptiometry [DXA] scan). In those at increased fracture risk, the median 10-year probability of hip and major osteoporotic fracture was 11.2% and 22.8%, vs 4.1% and 11.5% in those deemed not at risk. An osteoporosis diagnosis was recorded in 804 patients (21.2%); most (79.7%) of these were at increased fracture risk. The treatment gap was 74.6%, varying from 53% in Ireland to 91% in Germany. Patients with an osteoporosis diagnosis were found to have a lower treatment gap than those without a diagnosis, with an absolute reduction of 63%. Conclusions There is a large treatment gap in women aged ≥ 70 years at increased risk of fragility fracture in routine primary care across Europe. The gap appears to be related to a low rate of osteoporosis diagnosis.

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Section: Introductionmentioning

confidence: 99%

The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

McCloskey

Rathi²,

Heijmans³

et al. 2020

Osteoporos Int

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“…Orthogeriatric models of care have demonstrated being the future for the elderly fractured patient, with a special interest in the organization of an additional estructure of secondary prevention that it is giving extraordinary results, the Fracture Liason Services. 128,[142][143][144][145]…”

Section: Discussionmentioning

confidence: 99%

“…Recently, fracture units (FLS) have also been implemented, where the cause is studied, patients are monitored, and secondary prevention of osteoporosis is undertaken, also achieving better adherence to the treatment, improvement in BMD, and a reduction in new fractures as well as mortality. 137,144,145 Both methods, Orthogeriatric Units and FLS, must be considered as a work mode when the objective is the secondary prevention of fractures in geriatric patients.…”

Section: Methods For the Treatment Of Fractures And The Secondary Prevmentioning

confidence: 99%

Efficacy, cost, and aspects to take into account in the treatment of osteoporosis in the elderly

Sáez-López

Etxebarría-Foronda

Lampré³

et al. 2019

Revista Española de Geriatría y Gerontología

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Age is one of the principal risk factors for development of frailty fractures. Age pyramids show a population that is becoming increasingly more elderly, with an increasing incidence of fractures, and the forecasts for the future are truly alarming. Adequate handling of these patients who are especially at risk, at both the preventive and care levels, with a well-defined orthogeriatric model is necessary to respond to this clinical challenge. The objective of this review is to analyze the efficacy of the different strategies for the handling of geriatric patients with fracture risk.

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“…The workforce impact and issues surrounding the running of an FLS were assessed in a qualitative analysis of interviews with 43 health professionals in the United Kingdom, all of whom had been involved in FLS [41]. Significant themes included communication, resourcing and adherence.…”

Section: Evidence For Effectiveness Of Flsmentioning

confidence: 99%

Fracture Risk Assessment and How to Implement a Fracture Liaison Service

Fuggle

Javaid

Fujita³

et al. 2020

Practical Issues in Geriatrics

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Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England

Cited by 43 publications

References 120 publications

The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

Efficacy, cost, and aspects to take into account in the treatment of osteoporosis in the elderly

Fracture Risk Assessment and How to Implement a Fracture Liaison Service

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