Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation

BackgroundSuicide and homelessness share many of the same risk factors, but there is little understanding of how they are related to each other.MethodsData on 36 155 US adults (3101 veterans and 33 024 non-veterans) in the National Epidemiological Survey of Alcohol and Related Conditions-III were analysed to examine the association between lifetime homelessness and suicide, net of other factors, in a nationally representative US sample.ResultsUS veterans with homeless histories were 7.8 times more likely to have attempted suicide than veterans with no homeless histories (24.5% vs 2.8%). Non-veterans with homeless histories were 4.1 times more likely to have attempted suicide than those with no homeless histories (23.1% vs 4.5%). Lifetime homelessness was independently associated with lifetime suicide attempts in veterans (AOR=3.75, 95% CI 3.72 to 3.77) and non-veterans (AOR=1.83, 95% CI 1.83 to 1.84).ConclusionThe findings suggest a unique link between homelessness and suicide, especially among US veterans. Strategies to synergise homeless and suicide prevention services, particularly in the Veterans Health Administration, may benefit high-risk individuals.

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Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention?

Archives of Osteoporosis ◽

10.1007/s11657-020-00832-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Michael Toal ◽

Connor McLoughlin ◽

Nicole Pierce ◽

Julie Moss ◽

Sarah English ◽

...

Keyword(s):

Quality Improvement ◽

Bone Density ◽

Vertebral Fractures ◽

Fracture Prevention ◽

Fracture Liaison Service ◽

Radiology Department ◽

Secondary Fracture ◽

Secondary Fracture Prevention ◽

Prevention Services ◽

Fracture Liaison

Abstract Summary We introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment. Purpose Identification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS). Methods We introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service. Results Recruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology ‘fracture’ increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up. Conclusions Standardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.

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Introducing mobile fracture prevention services with DXA in Northern Scotland: a comparative study of three rural communities

Osteoporosis International ◽

10.1007/s00198-020-05316-0 ◽

2020 ◽

Vol 31 (7) ◽

pp. 1305-1314

Author(s):

R. J. Hollick ◽

L. McKee ◽

J. Shim ◽

N. Ramsay ◽

S. Gerring ◽

...

Keyword(s):

Rural Communities ◽

Comparative Study ◽

Fracture Prevention ◽

Prevention Services

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First results of the register of patients with osteoporosis included in the secondary fracture prevention services

Russian Journal of Geriatric Medicine ◽

10.37586/2686-8636-2-2021-201-208 ◽

2021 ◽

pp. 211-218

Author(s):

K. Yu. Belova ◽

E. V. Bublik ◽

E. N. Gladkova ◽

H. G. Gordjeladze ◽

E. N. Dudinskaya ◽

...

Keyword(s):

Osteoporotic Fractures ◽

Fracture Prevention ◽

Fracture Liaison Service ◽

International Standards ◽

Secondary Fracture ◽

Secondary Fracture Prevention ◽

Prevention Services ◽

First Results ◽

Risk Of Falls ◽

Processing Information

Background. To reduce the number of osteoporotic fractures in the world in recent years, — Fracture Liaison Service has been created. Since 2019, the development of a register of patients included in the Secondary Fracture Prevention named «Prometheus» has begun in Russia.Materials and methods. An information system for storing, searching and processing information has been created, and a registration card has been developed. Six FLS participate in the register management. As of 10.03.2021, data on 387 patients were introduced in the register.Results. Among the included patients, 46.25% received a fracture of the proximal femur, 20.41% — of the vertebral bodies and 16.80% of the proximal humerus, the rest had fractures of other localizations. The risk of fractures was assessed in all patients. A high risk of major osteoporotic fractures according to FRAX was determined in 160 (43.24%) people. Two-energy X-ray absorptiometry (DXA) was performed in 152 (39.28%) patients, and osteoporosis was detected in 103 (67.76%), osteopenia — in 42 (27.63%) patients. The risk of falls was assessed in 100% of the included patients, and the risk of falls was determined to be high in 343 (88.63%) patients. Evaluation of various laboratory parameters to find the causes of secondary osteoporosis was performed in most patients. After consultation with the FLS doctor, anti-osteoporotic drugs were prescribed to 241 (64.27%) people. Among the rest, 70 (52.24%) patients had contra-indications and 31 (23.13%) people needed further examination.Conclusions. Thus, the use of the register allows you to evaluate all the main sections of the organization of assistance within the FLS and compare them with international standards to identify «gaps» and improve the work of the service.

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