Post-fracture care gap: a retrospective population-based analysis of Hong Kong from 2009 to 2012

Cheung, MY; Ho, Wing Hang Angela; Wong, SH

doi:10.12809/hkmj187227

Cited by 10 publications

(17 citation statements)

References 25 publications

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“…While many such studies are based in North America [19-22, 25, 26, 28], our study along with several Fig. 2 The treatment gap in the United Kingdom stratified according to fracture location (all, hip, spine, non hip non spine, and wrist fractures, respectively) and time period others demonstrate that the treatment gap seems to be a universal problem [23,24,30], also pertaining to European healthcare systems with a high level of access. Previous longitudinal studies have demonstrated an increasing treatment gap over time [25,26], and while our study provides more recent data with significant differences between the UK, Catalonia, and Denmark, the overall impression is that the gap is stable or increasing in recent years.…”

Section: Discussionmentioning

confidence: 52%

“…Despite such evidence-based recommendations, a significant post-fracture treatment gap is known to prevail across healthcare systems and settings [19][20][21][22][23][24][25][26][27][28]. Several publications report that in some countries as few as 10-20% of patients with fragility fractures go on to receive AOM [23][24][25][26][27], with this gap being more pronounced in men as well as in the elderly [20,26,29]. Despite the attention given to the importance of closing the treatment gap, long-term time trends seem to indicate that the gap has even been increasing in recent years [25,26].…”

Section: Introductionmentioning

confidence: 99%

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Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

et al. 2020

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This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed. Introduction Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an antiosteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015. Methods This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture. Results A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women. Conclusion Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

et al. 2020

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“…Die Diagnoserate lag mit 17,2 % deutlich unter den 35 %, die in der Studienplanung angesetzt wurden. Im internationalen Vergleich werden jedoch selbst bei Patienten mit ausschließlich hüftgelenksnahen Frakturen niedrige Diagnose-und Therapieraten von 10-35 % 1 Jahr poststationär berichtet [10,11]. Auch für andere Frakturlokalisationen lagen die Diagnose-und Therapieraten in diesem Bereich [12].…”

Section: Ergebnis Der Dual-energy X-ray Absorptiometryunclassified

“…Bei stationären und rehabilitativen Behandlungskosten von 10 000-15 000 € pro hüftgelenksnaher Fraktur, geschätzten Steigerungsraten um das 3,5-Fache bis zum Jahr 2050 und geschätzten 5,4 Mrd. € direkter Kosten in Deutschland pro Jahr durch die Versorgung von osteoporoseassoziierten Frakturen bergen schon geringe flächendeckende Verbesserungen in der Nachsorge unglaubliches Einsparpotenzial [11]. Schon im Jahre 2003 lagen die durchschnittlichen Behandlungskosten einer stationären Therapie infolge einer osteoporotischen Fraktur bei 9962 € und somit exorbitant höher als die durchschnittlichen 281 € Therapiekosten pro Jahr für einen an Osteoporose erkrankten Patienten ohne Fraktur [3].…”

Section: Ergebnis Der Dual-energy X-ray Absorptiometryunclassified

“…Durch die Bildung von sektorenübergreifenden Netzwerken mit einem geriatrisch-orthopädischen-unfallchirurgischen Hintergrund, die perioperativ und früh postoperativ aktiviert werden, kann eine deutliche Verbesserung der Nachsorge von Frakturpatienten erreicht werden [11]. Den regionalen Beweis, dass die hierfür benötigte Expertise und Kapazität vorhanden ist, konnte diese Studie erbringen.…”

Section: Schlussfolgerungunclassified

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Dresdener Network Osteoporosis

Fülling

Bula²,

Defèr³

et al. 2020

Z Orthop Unfall

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Purpose On a global scale the main focus of traumatological therapy lies in the treatment of unintentional injuries or victims of violence. People of all ages and through all economic groups can be affected. Due to demographic change in Western industrial countries, however, this focus increasingly shifts towards fragility fractures. In Europe osteoporosis is the most common bone disease in advanced age. Secondary prevention programs like the Fracture Liaison Service (FLS) are becoming increasingly prevalent, especially in Anglo-American health care systems. In German orthopedic and trauma wards and hospitals, however, the FLS is still relatively uncommon. This article will examine the question whether secondary prevention programs like FLS need to be established in the German health care system. This study aims at finding out, whether in the area of a medium sized German city there is a difference regarding the initiation of osteoporosis diagnosis and therapy between the regular aftercare by the general practitioner or the orthopedic surgeon and the aftercare by a specialist trained in osteology (Osteologe). Materials and Methods For the open, randomized prospective study 70 patients with low energy fractures were recruited, who were older than 60 years and have been treated in our department. Results 58 out of 70 patients have completed the study, which amounts to a follow-up of 82.9%. Limited mobility and a high degree of organizational effort were the main reasons for early termination of the study. While in the group with regular aftercare, only 2 out of 29 patients received a specific osteoporosis treatment, in group who were directly transferred to a specialist trained in osteology 17 out of 29 patients received specific treatment. After re-evaluation of group with regular aftercare in 21 out of 29 cases a specific osteoporosis treatment was recommended. Conclusions It could be established that there is a significant diagnosis and treatment gap regarding the aftercare of patients with fractures caused by osteoporosis between general practitioners or orthopedic surgeons on the one hand and the specialists trained in osteology on the other hand. To improve the aftercare of fracture patients, cross sectoral networks with a background in geriatrics and orthopedic-trauma surgery like a FLS need to be established in the German healthcare system.

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The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study

Thomas

Tubach

Bizouard

et al. 2020

Journal of Bone and Mineral Research

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Osteoporosis carries a high medical, economic, and societal burden principally because of the risk of severe fractures. The objective of this cost-of-illness study was to describe health resource utilization and associated costs in all patients aged ≥50 years hospitalized for a severe osteoporotic fracture over a 6-year period (2009 to 2014) in France. Data were extracted from the French national healthcare database (SNDS) on all health care resource utilization between the index date (date of hospitalization for first fracture during the enrollment period) and study end (December 31, 2016) or until the patient died. Costing was restricted to direct costs and determined from the payer perspective. Variables related to costs were identified through multivariate logistic regression analysis. A total of 356,895 patients were included (median follow-up 39.1 months). In the year after the index fracture, 36,622 patients (10.5%) were rehospitalized for a fracture-related reason. Only 18,474 (5.3%) underwent bone densitometry and 58,220 (16.7%) received a specific treatment. The total annual per capita osteoporosis-related cost in the year after the index severe osteoporotic fracture was €18,040 (from €8598 for multiple ribs to €21,085 for hip fracture) of which €17,905 was incurred by fracture-related costs. The cost incurred by management of osteoporosis was €135. Over years 2 to 5, the mean annual per capita costs of fracture treatment (€806, mostly attributable to the treatment of refractures) continued to dominate those of osteoporosis management (€99). Total annual cost of care was €1260 million (year 2014). Variables associated with higher cost were older age, male sex, site of fracture, a history of prior osteoporotic fracture, and the number of refracture events. The 5-year cost of severe osteoporotic fractures to the French health care system is high and mostly attributable to the treatment of refractures. Improved fracture prevention measures in patients with osteoporosis is crucial to reduce the economic burden of the disease.

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Post-fracture care gap: a retrospective population-based analysis of Hong Kong from 2009 to 2012

Cited by 10 publications

References 25 publications

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

Dresdener Network Osteoporosis

The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study

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