scholarly journals Clinical characteristics and impact of treatment gap of fragility fractures in Colombia: experience of 10 Fracture Liaison Services (FLS)

2021 ◽  
pp. 15-22
Author(s):  
Adriana Medina ◽  
Geraldine Altamar ◽  
Daniel G. Fernández-Ávila ◽  
Jaime Leal ◽  
Edgar Castro ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Fragility Fractures ◽  
Treatment Gap ◽  
Fracture Liaison Services ◽  
Fracture Liaison

scholarly journals Fragility fractures in Europe: burden, management and opportunities

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Fredrik Borgström ◽  
◽  
Linda Karlsson ◽  
Gustav Ortsäter ◽  
Nicolas Norton ◽  
...  
Keyword(s):  
Fragility Fractures ◽  
Chronic Obstructive ◽  
Economic Modelling ◽  
The European Union ◽  
Treatment Gap ◽  
Quality Adjusted Life Years ◽  
Fracture Liaison Services ◽  
Life Years ◽  
Fracture Liaison ◽  
Quality Adjusted Life

Abstract Summary This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years. Introduction Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6). Methods A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric. Results Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided. Conclusions Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.

scholarly journals Best Practice Framework of Fracture Liaison Services in Spain and their coordination with Primary Care

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
A. Naranjo ◽  
S. Ojeda ◽  
M. Giner ◽  
M. Balcells-Oliver ◽  
L. Canals ◽  
...  
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Performance Indicators ◽  
Best Practice ◽  
Fragility Fractures ◽  
Fracture Liaison Services ◽  
And Performance ◽  
Practice Framework ◽  
Fracture Liaison

Abstract Summary The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. Purpose To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. Methods A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. Results Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. Conclusions The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.

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 Implementation of an integrated care programme to avoid fragility fractures of the hip in older adults in 18 Bavarian hospitals – study protocol for the cluster-randomised controlled fracture liaison service FLS-CARE

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isabel Geiger ◽  
◽  
Christian Kammerlander ◽  
Christine Höfer ◽  
Ruth Volland ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Healthcare System ◽  
Fragility Fractures ◽  
Term Care ◽  
Care Programme ◽  
Secondary Fracture ◽  
Cluster Randomised ◽  
German Healthcare System ◽  
Randomised Controlled ◽  
Fracture Liaison

Abstract Background The economic and public health burden of fragility fractures of the hip in Germany is high. The likelihood of requiring long-term care and the risk of suffering from a secondary fracture increases substantially after sustaining an initial fracture. Neither appropriate confirmatory diagnostics of the suspected underlying osteoporosis nor therapy, which are well-recognised approaches to reduce the burden of fragility fractures, are routinely initiated in the German healthcare system. Therefore, the aim of the study FLS-CARE is to evaluate whether a coordinated care programme can close the prevention gap for patients suffering from a fragility hip fracture through the implementation of systematic diagnostics, a falls prevention programme and guideline-adherent interventions based on the Fracture Liaison Services model. Methods The study is set up as a non-blinded, cluster-randomised, controlled trial with unequal cluster sizes. Allocation to intervention group (FLS-CARE) and control group (usual care) follows an allocation ratio of 1:1 using trauma centres as the unit of allocation. Sample size calculations resulted in a total of 1216 patients (608 patients per group distributed over 9 clusters) needed for the analysis. After informed consent, all participants are assessed directly at discharge, after 3 months, 12 months and 24 months. The primary outcome measure of the study is the secondary fracture rate 24 months after initial hip fracture. Secondary outcomes include differences in the number of falls, mortality, quality-adjusted life years, activities of daily living and mobility. Discussion This study is the first to assess the effectiveness and cost-effectiveness/utility of FLS implementation in Germany. Findings of the process evaluation will also shed light on potential barriers to the implementation of FLS in the context of the German healthcare system. Challenges for the study include the successful integration of the outpatient sector as well as the future course of the coronavirus pandemic in 2020 and its influence on the intervention. Trial registration German Clinical Trial Register (DRKS) 00022237, prospectively registered 2020-07-09

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

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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