Outcomes of an osteoporosis disease‐management program managed by nurse practitioners

Greene, Denise; Dell, Richard

doi:10.1111/j.1745-7599.2010.00515.x

Cited by 45 publications

(29 citation statements)

References 23 publications

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“…The “4i” Lucky Bone FLS in Montreal, Canada, demonstrated that there was overwhelming consensus between their physicians and the decisions made by their specialist nurses when they were empowered within a system involving an order set to allow them to investigate and manage patients,24 suggesting that such a service can be safely and efficiently run with minimal supervision from physicians 35. In terms of identifying patients at risk of osteoporosis, most services would initiate an assessment in patients over the age of 50 years presenting with a fragility fracture,21,25,26,28 although some centers also included women as young as 40 22. Fragility fractures are those sustained following minimal trauma, eg, fall from a standing height, and those considered typical of osteoporotic fragility fractures 36…”

Section: Models Of Flsmentioning

confidence: 99%

Fracture liaison services: improving outcomes for patients with osteoporosis

Walters

Khan

Ong

et al. 2017

CIA

132

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Fragility fractures are sentinels of osteoporosis, and as such all patients with low-trauma fractures should be considered for further investigation for osteoporosis and, if confirmed, started on osteoporosis medication. Fracture liaison services (FLSs) with varying models of care are in place to take responsibility for this investigative and treatment process. This review aims to describe outcomes for patients with osteoporotic fragility fractures as part of FLSs. The most intensive service that includes identification, assessment and treatment of patients appears to deliver the best outcomes. This FLS model is associated with reduction in re-fracture risk (hazard ratio [HR] 0.18–0.67 over 2–4 years), reduced mortality (HR 0.65 over 2 years), increased assessment of bone mineral density (relative risk [RR] 2–3), increased treatment initiation (RR 1.5–4.25) and adherence to treatment (65%–88% at 1 year) and is cost-effective. In response to this evidence, key organizations and stakeholders have published guidance and framework to ensure that best practice in FLSs is delivered.

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Section: Models Of Flsmentioning

confidence: 99%

Fracture liaison services: improving outcomes for patients with osteoporosis

Walters

Khan

Ong

et al. 2017

CIA

132

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“…Other interventions, such as the development of an osteoporosis exemplary-care program that identified, educated, evaluated, referred, and treated patients at risk of fracture through coordination among orthopaedists, a metabolic bone disease clinic, and nuclear medicine, have had more success; a study of 430 Canadians found nearly 96% receive appropriate attention after a fracture [3]. Another model for osteoporosis disease management is the Healthy Bones program of Kaiser Permanente Southern California (Kaiser SCAL), a health maintenance organization (HMO) [9,12]. Kaiser SCAL has an electronic medical records (EMR) system that can track DXA scans, fractures, and medication use.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

Gender Differences in Osteoporosis and Fractures

Cawthon

2011

Clinical Orthopaedics &Amp; Related Research

249

153

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Background Osteoporosis is generally thought of as a ''woman's disease'' because the prevalence of osteoporosis and the rate of fractures are much higher in postmenopausal women than in older men. However, the absolute number of men affected by osteoporosis and fractures is large, as at least 2.8 million men in the United States are thought to have osteoporosis. Questions/purposes The purposes of this review are to (1) highlight gender differences in osteoporosis and fracture risk, (2) describe disparities in treatment and outcomes after fractures between men and women, and (3) propose solutions to reducing disparities in treatment and prevention. Methods A literature survey was conducted using MEDLINE with a variety of search terms and using references from the author's personal collection of articles. A formal search strategy and exclusion criteria were not employed and the review is therefore selective. Where are we now? Postmenopausal women have a higher prevalence of osteoporosis and greater incidence of fracture than older men. Despite the higher fracture risk in postmenopausal women, older men tend to have worse outcomes after fracture and poorer treatment rates, although less is known about the disease course in men.Multifaceted interventions to improve the screening and treatment for osteoporosis were recently developed. Where do we need to go? Improvement in treatment rates of those at risk, regardless of gender, is an important goal in osteoporosis management. How do we get there? Further development and evaluation of cost-effective, multifaceted interventions for screening and treatment of osteoporosis and fractures are needed; such interventions will likely improve the primary prevention of fractures.

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“…The inpatient and outpatient modules of the EMR were used to identify diagnostic codes associated with periprosthetic fractures using the fractures and dual-energy x-ray absorptiometry (DEXA) scan results of members of the KPSC health care system was used to obtain bone mineral density results and verify periprosthetic fractures. Details on this data source and its processes have been published elsewhere [9][10][11].…”

mentioning

confidence: 99%