Seasonality of adult fragility fractures and association with weather: 12-year experience of a UK fracture liaison service

SummaryIndividuals who have suffered fractures caused by osteoporosis – also known as fragility fractures – are the most readily identifiable group at high risk of suffering future fractures. Globally, the majority of these individuals do not receive the secondary preventive care that they need. The Fracture Liaison Service model (FLS) has been developed to ensure that fragility fracture patients are reliably identified, investigated for future fracture and falls risk, and initiated on treatment in accordance with national clinical guidelines. FLS have been successfully established in Asia, Europe, Latin America, North America and Oceania, and their widespread implementation is endorsed by leading national and international osteoporosis organisations. Multi-sector coalitions have expedited inclusion of FLS into national policy and reimbursement mechanisms. The largest national coalition, the National Bone Health Alliance (NBHA) in the United States, provides an exemplar of achieving participation and consensus across sectors. Initiatives developed by NBHA could serve to inform activities of new and emerging coalitions in other countries.

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Fragility Vertebral Compression Fractures in Postmenopausal Women: The Role of a Fracture Liaison Service Program

The American Surgeon ◽

10.1177/0003134820933254 ◽

2020 ◽

pp. 000313482093325

Author(s):

Avery Jackson ◽

Tarik Wasfie ◽

Caramarie Brock ◽

Stefanija Galovska ◽

Melany Smalley ◽

...

Keyword(s):

Vitamin D ◽

Postmenopausal Women ◽

Fragility Fractures ◽

Fracture Liaison Service ◽

Vertebral Compression Fractures ◽

Compression Fractures ◽

Vitamin D Levels ◽

Group A ◽

Group B ◽

Fracture Liaison

Background As the aging population increases in the United States, so has the prevalence of osteoporosis (10.2 million adults aged 50 years and older in 2010). Programs to manage the increased incidence of fragility fractures in such patients particularly the postmenopausal women are the priority. Programs such as the Fracture Liaison Service (FLS) might be the answer. Methods Data of 256 postmenopausal women with vertebral compression fractures treated with vertebroplasty between 2012 and 2017 were divided into 2 groups. Group A were patients seen between 2012 and 2014 before the establishment of the FLS program at the clinic. Group B were patients seen between 2015 and 2017 who presented to the FLS program in our clinic. Data collected included demographics, refracture rates, dual-energy X-ray absorptiometry (DEXA) scan T-scores, fracture risk score (FRAX), serum calcium and vitamin D levels, and comorbid conditions. Results There were 103 female patients with a mean age of 79.75 years (standard deviation [SD] ± 10.86) in group A, while group B had 153 patients with a mean age of 75.66 years (SD ± 10.78). There was no significant difference in the DEXA scan T-scores, FRAX scores, and mean serum calcium and vitamin D levels; however, there was a significant reduction in the refracture rate for vertebral compression fractures ( P = .003). Conclusion FLS programs, when implemented, will have a beneficial effect in reducing refracture rates of postmenopausal women with osteoporotic fragility fractures.

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Barriers to the identification of fragility fractures for secondary fracture prevention in an orthopaedic clinic-based fracture liaison service

Current Orthopaedic Practice ◽

10.1097/bco.0000000000000691 ◽

2018 ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Andréa Senay ◽

Josée Delisle ◽

Andreea Banica ◽

G. Yves Laflamme ◽

Stéphane Leduc ◽

...

Keyword(s):

Fragility Fractures ◽

Fracture Prevention ◽

Fracture Liaison Service ◽

Secondary Fracture ◽

Secondary Fracture Prevention ◽

Orthopaedic Clinic ◽

Fracture Liaison

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Does a Fracture Liaison Service Program Minimize Recurrent Fragility Fractures in the Elderly With Osteoporotic Vertebral Compression Fractures?

Neurosurgery ◽

10.1093/neuros/nyz310_821 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Tarik Wasfie ◽

Avery M Jackson

Keyword(s):

Retrospective Chart Review ◽

Fragility Fractures ◽

The United States ◽

Fracture Liaison Service ◽

Vertebral Compression Fractures ◽

P Value ◽

Compression Fractures ◽

Group A ◽

Group B ◽

Fracture Liaison

Abstract INTRODUCTION There is a sizable proportion of elderly, both men and women, with fragility fractures, approximately 2 million fractures per year in the United States. METHODS A retrospective chart review of 365 patient presented between January 2012 and December 2017 with vertebral compression fractures. Prepost study design to determine refracture between group A (before Fracture Liaison Service (FLS)) and group B, after calcium, vitamin D, DEXA scans, FRAX scores, and refracture rates were measured. RESULTS Mean age for group A and B were 79.0 and 74.9 yr, respectively, and predominantly females. Serum calcium was higher in group B (9.51 mg/DL) but not significan (P = .19). Fracture score among the groups was similar (20% vs 22%; P = .44). The total refracture rate for both vertebral and other fracture was significantly less in the post FLS patients, 36.5% vs 56% P-value = .01. CONCLUSION FLS program benefited patients with fragility fractures by decreasing the incidence of all refracture rates.

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The impact of a standardized order set for the management of non-hip fragility fractures in a Fracture Liaison Service

Osteoporosis International ◽

10.1007/s00198-016-3669-5 ◽

2016 ◽

Vol 27 (12) ◽

pp. 3439-3447 ◽

Cited By ~ 4

Author(s):

A. Senay ◽

J. Delisle ◽

M. Giroux ◽

G. Y. Laflamme ◽

S. Leduc ◽

...

Keyword(s):

Fragility Fractures ◽

Fracture Liaison Service ◽

The Impact ◽

Fracture Liaison ◽

Order Set

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Evaluation of minimal fracture liaison service resource: costs and survival in secondary fracture prevention—a prospective one-year study in South-Finland

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01826-x ◽

2021 ◽

Author(s):

P. Lüthje ◽

I. Nurmi-Lüthje ◽

N. Tavast ◽

A. Villikka ◽

M. Kataja

Keyword(s):

Secondary Prevention ◽

Excess Mortality ◽

Assessment Tool ◽

Fragility Fractures ◽

Fracture Prevention ◽

Fracture Liaison Service ◽

Low Energy ◽

Secondary Fracture ◽

Dxa Scans ◽

Fracture Liaison

Abstract Background Fracture liaison service (FLS) is a secondary prevention model for identification of patients at risk for fragility fractures. Aims This study was conducted to evaluate the number and costs of secondary prevention of low-energy fractures in the city of Kouvola in Finland. Methods Women aged ≥ 45 years and men ≥ 60 years treated in the emergency department with a low-energy fracture were identified. Laboratory testing, BMI, and DXA scans were performed. Fracture Risk Assessment Tool was used. The direct FLS costs were calculated. Survival was analyzed using univariate and multivariate analysis and the life-table method. Results 525 patients with 570 fractures were identified. The mean age of women was 73.8 years and of men 75.9 years. Most patients sustained wrist (31%), hip (21%) or proximal humerus (12%) fractures. 41.5% of the patients had osteoporosis according to DXA scans. 62% of patients used calcium and vitamin D daily and 38% started anti-osteoporotic medication. Protective factors for survival were: age < 80 years, female sex, and S-25OHD concentration of 50–119 nmol/L. Excess mortality was highest among patients with a fracture of the femur. The total annual direct costs of FLS were 1.3% of the costs of all fractures. Discussion Many low-energy fracture types were associated with excess mortality. The use of anti-osteoporotic medication was not optimal. Conclusions FLS increased the catchment of low-energy fracture patients and was inexpensive. However, identification, evaluation and post-fracture assessment of patients should be expedited. Rehabilitation of hip fracture patients needs to be improved.

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Secondary prevention of fragility fractures: instrumental role of a fracture liaison service to tackle the risk of imminent fracture

Hong Kong Medical Journal ◽

10.12809/hkmj187593 ◽

2019 ◽

pp. 235-242 ◽

Cited By ~ 3

Author(s):

Ronald MY Wong ◽

◽

SW Law ◽

KB Lee ◽

Simon KH Chow ◽

...

Keyword(s):

Secondary Prevention ◽

Fragility Fractures ◽

Fracture Liaison Service ◽

Fracture Liaison ◽

Instrumental Role

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Does Fracture Liaison Service Improves Fracture Risk Assessment among Patients with Fragility Fractures? A Systematic Review

10.21203/rs.3.rs-924059/v1 ◽

2021 ◽

Author(s):

Anum Sadruddin Pidani ◽

Shahryar Noordin ◽

Joanna Sale

Keyword(s):

Systematic Review ◽

Risk Assessment ◽

Fracture Risk ◽

Fragility Fracture ◽

Literature Search ◽

Fragility Fractures ◽

Fracture Liaison Service ◽

Fracture Risk Assessment ◽

Fracture Liaison

Abstract Background: The fragility fractures can cause substantial pain, disability, reduced quality of life and mortality. The probability of sustaining subsequent fractures increases up to five times after an initial fragility fracture. The Fracture Liaison Service is a coordinated model of care that aims to bridge the post-fracture care gap by improving subsequent fracture risk assessment and post-fracture management. However, there are very few studies that included fracture risk assessment as a significant outcome of an FLS program. This systematic review aims to evaluate the available evidence on the effect of FLS in improving fracture risk assessment among fragility fracture patients Method: A systematic literature search will be carried out on the major electronic databases including PubMed, Embase, CINAHL Plus, and Cochrane to identify the outcomes of Fracture Liaison Service. The literature search will not be restricted to the context and year of publication. Two researchers will independently conduct the databases search. We will pilot the search strategy to ensure sufficient sensitivity and specificity. The JBI critical appraisal tools will be used to assess methodological quality of all the included studies. Discussion: This review will highlight an urgent need for more studies from different geographical areas to determine best practices for implementing fracture risk assessment globally and guiding clinical decision making for osteoporosis management. The findings of this systematic review will highlight the importance of including fracture risk assessment as a significant parameter to evaluate FLS programs implemented across the globe. Conclusion: This systematic review will provide more information about fracture risk assessments and its reporting. It will also highlight the variations in the methods of performing a fracture risk assessment with and without BMD testing and the impact of the FLS program in improving fracture risk assessment.

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