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

2018 ◽  
pp. 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

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

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.

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

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.

scholarly journals A New Fracture Liaison Service Design Using a Mobile Application and Medical Artificial Intelligence (Preprint)

2018 ◽  
Author(s):  
Sung Woo Kim ◽  
Young Jun Won
Keyword(s):  
Mobile Application ◽  
Osteoporotic Fractures ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Open Policy ◽  
Android Os ◽  
Secondary Fractures ◽  
Fracture Liaison

BACKGROUND While the clinical design of a Fracture Liaison Service(FLS) has been used as a localized healthcare service in a previous study, thus far there has not been an international mobile application, such as a FLS using smart phones. OBJECTIVE The goal of our study is to improve the prevention of secondary fractures using a Mobile FLS Application. METHODS We have developed a Fracture Liaison Service as an Android-OS application and released this service as a secondary fracture prevention program for osteoporotic fracture patients. RESULTS We have released the final version of the FLS mobile application in Google’s PlayStore. The new model of the FLS mobile application can be practically commercialized, and the effective second-order fracture prevention system is based on an open policy platform. CONCLUSIONS We hope to contribute to the prevention and management of osteoporotic fractures and osteoporosis worldwide via this FLS mobile application. In the future, an intelligent personal FLS is definitely possible, by applying a Medical AI based on a huge DB.

scholarly journals Fragility Fracture Prevention—Implementing a Fracture Liaison Service in a High Volume Orthopedic Hospital

2019 ◽  
Vol 16 (24) ◽  
pp. 4902
Author(s):  
Pennestrì ◽  
Corbetta ◽  
Favero ◽  
Banfi
Keyword(s):  
Fragility Fracture ◽  
Fragility Fractures ◽  
High Volume ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Clinical Indicators ◽  
Secondary Fracture ◽  
Early Evaluation ◽  
Orthopedic Hospital ◽  
Fracture Liaison

Fragility fractures pose a serious threat to patient health, quality of life, and healthcare sustainability. In order to reduce their clinical, social, and economic burden, a Fracture Liaison Service (FLS) was introduced in a high volume orthopedic hospital in 2017. The purpose of this retrospective observational study is to describe the FLS protocol, introduce its preliminary outcomes, and provide an early evaluation in light of international guidelines and recommendations. All the performances suggested by the International Osteoporosis Foundation (IOF) are provided under the same institution by which a patient is admitted for surgery. Clinical indicators from patient history and administrative indicators from the hospital database have been used to estimate the spread of fragility fracture prevention and the degree of patient compliance to these programs. The research included 403 patients. Although, almost 1/3 were admitted for the second fragility fracture, only half received anti-osteoporotic treatment before it. The degree of prevention was even lower in the case of patients admitted for the first fragility fracture. The risk of being affected by a secondary fracture was seven times higher when patients did not attend any follow-up or diagnostic exam. In order to identify the main determinants of compliance with FLS and perform a cost-effectiveness analysis on a larger sample, it is fundamental to integrate data from different providers.

Systematic approaches to fragility fracture prevention

2014 ◽  
Vol 23 (01) ◽  
pp. 39-44
Author(s):  
D. B. Lee ◽  
P. J. Mitchell
Keyword(s):  
Fragility Fracture ◽  
National Policy ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
The United States ◽  
Fracture Liaison Service ◽  
Reimbursement Mechanisms ◽  
Future Fracture ◽  
National Coalition ◽  
Fracture Liaison

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.

scholarly journals Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laurna Bullock ◽  
Fay Crawford-Manning ◽  
Elizabeth Cottrell ◽  
Jane Fleming ◽  
Sarah Leyland ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Evidence Synthesis ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Delphi Survey ◽  
Shared Decision ◽  
Secondary Fracture ◽  
Drug Treatments ◽  
Fracture Liaison

Abstract Summary Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. Purpose The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the ‘model Fracture Liaison Service (FLS) consultation’ within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. Methods A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was ‘essential’ and percentage agreement calculated; the study team subsequently determined the threshold for essential content. Results Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. Conclusions This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.

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