Fracture Liaison Service Research Articles

P021 Quality Improvement Project: Improving Osteoporosis Treatment for Patients with a Neck of Femur Fracture

Abstract Background/Aims The Fracture Liaison Service (FLS) identifies patients >50 who have sustained a fragility fracture (FF). These patients need prompt assessment and decision on appropriate treatment for osteoporosis in order to reduce their risk of sustaining further FFs. Without treatment, 1/5 patients can go on to have a further FFs which carry significant risk to mortality and morbidity. Zoledronate is a bone agent that halves the risk of another FF. Patients with a neck of femur fracture (#NOF) present as one of the most at-risk groups for a further FF. These patients are generally elderly and frail and attendance to outpatient hospital appointments are difficult. Therefore, transforming the FLS from an out-patient-based service, to one that is streamlined to systematically identify and opportunistically treat patients whilst they are still in hospital means delivering timely, effective and efficient patient-centred care. Methods We used various Plan-Do-Study-Act cycles to aim to deliver Zoledronate to ≥ 90% of appropriately assessed in-patients >60 who have had a #NOF within a year of commencing QIP. Results PDSA cycle 1-Involvement of ortho-geriatrician: P-Improve working relationship with ortho-geriatrician with an interest in bone health over a 6-month period; D-Regular meetings with wider MDT; S-Priority of bone health assessments made greater through ward round documentation; A-Expand knowledge throughout the wider ortho-geriatrician team. PDSA cycle 2-Timing of Zoledronate delivery: P-Literature review regarding delivery of Zoledronate timing; D-Discuss as MDT; S-No evidence to suggest delay in fracture healing if given on day 7; A-Adopted process and communicated. PDSA cycle 3-FLS team on the wards as a result of PDSA cycle 2 not improving treatment outcomes: P-FLS nurses to join ortho-geriatrician ward round twice-weekly for 3-month trial period; D-Bank holidays and spike in Covid cases presented a challenge. Solution: Improvement of MDT relationships; S-At the end of the trial period an increase in patients who received treatment was shown and proved our prediction; A-Adaptation to documentation in FLS to streamline and reduce duplication. Conclusion The ability to deliver Zoledronate to ≥ 90% of appropriate patients with a #NOF as an inpatient was reached after 8 months of initiating QIP. Furthermore, maintaining this was consistently achieved throughout the following year and beyond. A few of the main reasons for this included earlier drug delivery, having a dedicated ortho-geriatrician as part of the FLS, and the FLS team attending the wards. A prompt bone health assessment of patients has enabled appropriate treatment to be delivered efficiently. The delivery of Zoledronate as an in-patient has meant that a significantly greater proportion of patients receive treatment, and sooner, in comparison to awaiting an outpatient assessment (that they may not attend). Therefore, this QIP has demonstrated time- and cost-effective management of patients with #NOF requiring Zoledronate. Disclosure G. O'Hara: None. E. Stanley: None. S. Broadhurst: None. M. Hui: None.

P079 Use of an electronic text messaging service to improve efficiency in initial Fracture Liaison Service Patient Assessment

Abstract Background/Aims Fracture Liaison Service (FLS) is labour intensive. It aims to identify all patients aged over 50 years presenting with a new fragility fracture and assess for treatment, in order to prevent future fractures and associated morbidity and mortality. According to the Royal Osteoporosis Society published Standards (2015), patients should have a comprehensive bone assessment within 3 months of the incident fracture. However, such assessments are time consuming, typically taking up to 40 minutes of an FLS practitioner's time. Understaffing led to designing an approach to gather information and streamline the Fracture Liaison service. Methods We approached an electronics communication company who generated a secure form containing the information required for FLS initial assessment. As a trial, all patients identified by the FLS as having a new fragility fracture between 15th November 2021 and 15th December 2021 were sent a text link to this questionnaire. A follow-up message was sent 1 day and 1 week later (3 messages in total). The questionnaires were then exported to the patient's electronic clinical record. Data collected included information allowing prediction of risk for future fractures. Following assessment of this data, action letters could be sent to the GP advising on a treatment plan, for example, to start an oral bisphosphonate or referral for parenteral treatment. We analysed the results and performed cost analysis based on comparison to normal practice where the initial assessment would have been undertaken as a clinic appointment. Results 43 out of 103 patients (42%) responded to the questionnaire. Of these 43 patients, 32 (74%) were female and the majority aged 60 to 79 years. Our cost analysis showed that allowing for a 30-minute face to face appointment for each of 43 patients would have taken 22.5 hours. By comparison, virtual assessment of the data from each questionnaire took only 8 minutes ie a total of 5.7 hours. This saved 16.8 hours of the FLS practitioner's time with a calculated cost saving of £352, based on professional time cost of £21 per hour. Face to face attendances would have cost £120 per patient ie £5160 for 43 patients. The total amount saved using the electronic questionnaire for 43 patients was £5512. Conclusion We were able to capture the initial FLS bone assessment data using an electronic questionnaire in 43 out of 103 patents. This resulted in a significant cost saving from outpatient clinics of £5512 over a 1-month period. Downstream processing of the data was much shorter. Further action will be to modify the text messages to increase yield of patients. Electronic fracture liaison is effective at reducing demands on the service and coordinating activity. We have demonstrated a significant cost saving on a small number of patients. Disclosure R. Reid: None. E. Lever: None. D. Davis: None.

Response to Letter to the Editor from Riahi and Gruntmanis: 'Inpatient Zoledronic Acid and Integrated Orthopedic and Fracture Liaison Services Improve Osteoporosis Treatment Rates'.

Journal Article Accepted manuscript Response to Letter to the Editor from Riahi and Gruntmanis: ‘Inpatient Zoledronic Acid and Integrated Orthopedic and Fracture Liaison Services Improve Osteoporosis Treatment Rates’ Get access WuQiang Fan, WuQiang Fan Massachusetts General Hospital, Boston, MA Correspondence: WuQiang Fan, MD, PhD. 15 Parkman Street, WACC Ste: 730A, Boston, MA 02114. Email: wfan2@mgh.harvard.edu. https://orcid.org/0000-0002-5081-4809 Search for other works by this author on: Oxford Academic Google Scholar Benjamin Z Leder, Benjamin Z Leder Massachusetts General Hospital, Boston, MA Search for other works by this author on: Oxford Academic Google Scholar Marcy B Bolster Marcy B Bolster Massachusetts General Hospital, Boston, MA Search for other works by this author on: Oxford Academic Google Scholar The Journal of Clinical Endocrinology & Metabolism, dgad161, https://doi.org/10.1210/clinem/dgad161 Published: 22 March 2023 Article history Received: 09 March 2023 Accepted: 15 March 2023 Published: 22 March 2023

Artículo traducido] Perfil clínico-epidemiológico del paciente atendido en una unidad multidisciplinar de fractura de cadera de un hospital de primer nivel en el noroeste de España

IntroductionHip fractures constitute a capital public health issue associated with aging and frailty because of its impact on both quality of life and morbidity and mortality in older people. Fracture liaison services (FLS) have been proposed as tools to minimize this emergent problem. Material and methodsA prospective observational study was conducted with 101 patients treated for hip fracture by the FLS of a regional hospital between October 2019 and June 2021 (20 months). Epidemiological, clinical, surgical, and management variables were collected during admission and up to 30 days after discharge. ResultsMean age of patients was 87.6 ± 6.1 years and 77.2% were female. Some degree of cognitive impairment was detected at admission in 71.3% of patients using the Pfeiffer questionnaire, and 13.9% were nursing home residents, and 76.24% could walk independently before the fracture. Fractures were more commonly pertrochanteric (45.5%). Patients were receiving antiosteoporotic therapy in 10.9% of cases. The median surgical delay from admission was 26 h (RIC 15–46 h), the median length of stay was 6 days (RIC 3–9 days) and in-hospital mortality was 10.9%, and 19.8% at 30 days, with a readmission rate of 5%. DiscussionPatients treated in our FLS at the beginning of its activity were similar to the general picture in our country in terms of age, sex, type of fracture, and proportion of patients treated surgically. A high mortality rate was observed, and low rates of pharmacological secondary prevention were followed at discharge. Clinical results of FLS implementation in regional hospitals should be assessed prospectively in order to decide their suitability.

Mortality and outcome in fragility hip fracture care during COVID-19 pandemic in Police General Hospital, Thailand

ObjectivesThe objective of this study is to assess outcomes and patient's mortality of Police General Hospital's fracture liaison service (PGH's FLS) during Coronavirus disease 2019 (COVID-19) outbreak comparing to the former period. MethodsRetrospective cohort study was performed in patients aged 50 or older who were admitted with fragility hip fracture in Police General Hospital, Bangkok, between January 1, 2018 to December 31, 2019 (before pandemic) comparing to January 1, 2020 to December 31, 2021 (pandemic) using the electronic database. The outcomes were mortality and other outcomes in one-year follow up. ResultsA total of 139 fragility hip fractures were recorded in 2018–2019 (before pandemic) compared with 125 in 2020–2021 (pandemic). The 30-day mortality in hip fracture numerically increased from 0% to 2.4% during the pandemic. One-year mortality was significantly escalated from 2 cases (1.4%) to 5 cases (4%) (P = 0.033). However, the cause of mortality was not related with COVID-19 infection. We also found a significantly shorter time to surgery but longer wait time for bone mineral density (BMD) testing and initiation of osteoporosis medication in pandemic period. ConclusionsThe results of this study in COVID-19 pandemic period, 1-year mortality rate was significantly higher but they were not related with COVID-19 infection. We also found longer time to initial BMD testing and anti-osteoporotic medication and more loss of follow up, causing lower anti-osteoporotic medication taking. In contrast, the time to surgery became shorter during the pandemic.

Fracture Liaison Service in Korea: 2022 Position Statement of the Korean Society for Bone and Mineral Research.

Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.

Fracture liaison services combined with online home nursing care in fragility hip fracture: a comparative effectiveness pilot study.

Among potential e-health platforms, mobile internet encompasses the largest user group of mobile instant messaging software in Asia and offers strong interaction, low cost, and fast speed. The online home nursing care model prevents unnecessary hospital admissions and readmissions. This study aims to explore the effects of a fracture liaison service (FLS) model combined with online home nursing care on patients with fragility hip fracture. Patients discharged after November 2020 received FLS care combined with online home nursing care. Patients discharged from May 2020 to November 2020 received only routine discharge guidance and were classified as the control group. The Parker Mobility Score (PMS), Medical Outcomes Study 36-item short-form health survey (MOS SF-36), general medication adherence scale (GMAS), complication rate, and fall/refracture rates were used to evaluate the efficacy of the FLS combined with online home nursing care during the 52-week follow-up period. Eighty-nine patients with complete follow-up information were included in the analysis at the 52-week follow-up. The FLS combined with online home nursing care was associated with improved osteoporosis patient care, including increased medication adherence (64.58% in the control group and 90.24% in the observation group), improved mental quality of life, reduced fall/refracture rate (12.5% and 4.88%, respectively), and reduced rates of bedsores and joint stiffness; however, there was no effect on functional recovery within 1year. We recommend the combination of FLS with online home nursing care, considering the local environment, to economically and conveniently monitor patients, reduce falls and refractures, and improve care and medication adherence.

In-Hospital Costs of Hemiarthroplasty in Patients with Osteoporotic Femoral Neck Fracture at Faculty of Medicine Siriraj Hospital

Background: The medical cost of osteoporotic hip fracture has become a great burden for the healthcare system. In Thailand, studies on the costs of bipolar hemiarthroplasty treatment for osteoporotic femoral neck fractures are limited and not up to date. Objective: To evaluate the in-hospital costs of treating the elderly with osteoporotic femoral neck fractures receiving hemiarthroplasty treatment. Materials and Methods: Patients with hip fractures who were 60 years or older and underwent bipolar hemiarthroplasty were prospectively observed. All patients were managed according to the Siriraj hip fracture fast-track and Fracture Liaison Service protocols. The authors collected details of the in-hospital costs incurred during the admission period and identified factors associated with an increasing in these costs. Results: Between February 1 and July 31, 2020, 50 patients were enrolled in the present study. Their average age was 78.3 years, and most had a Charlson comorbidity index of more than 5. The median total in-hospital costs for treatment were 5,013.25 USD with a range of 3,695.05 to 13,193.77 USD. Most of the total in-hospital costs occurred intraoperatively, with 29% of the total costs related to the cost of a prosthesis. The factors associated with an increase in costs were the length of stay (probability p<0.001) and postoperative pneumonia (p=0.038). Conclusion: In-hospital costs of hip fracture have become a great burden for patients and caregivers. Strategies to reduce total costs during hospitalization should focus on early surgery coupled with rehabilitation, which results in shorter stays. Keywords: Cost analysis; Femoral neck fracture; Hemiarthroplasty; In-hospital costs

The challenges associated with osteoporosis: the silent disease

Nursing and Residential CareVol. 25, No. 2 EditorialThe challenges associated with osteoporosis: the silent diseaseJulie Irene SwannJulie Irene SwannCorrespondence to: Julie Swann; E-mail Address: [email protected]Occupational therapist, UKSearch for more papers by this authorJulie Irene SwannPublished Online:11 Feb 2023https://doi.org/10.12968/nrec.2023.0004AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Centre for Metabolic Bone Diseases. Fracture risk assessment tool. 2019. https://frax.shef.ac.uk/FRAX/tool.aspx?country=1 (accessed 30 January 2023) Google ScholarNHS. Overview osteoporosis. 2022. https://www.nhs.uk/conditions/osteoporosis/ (accessed 30 January 2023) Google ScholarNational Institute for Care and Excellence. Osteoporosis-prevention of fragility fractures: what are the risk factors? 2021. https://cks.nice.org.uk/topics/osteoporosis-prevention-of-fragility-fractures/background-information/risk-factors/ (accessed 30 January 2023) Google ScholarRoyal College of Physicians. Strong bones after 50: fracture liaison services explained. 2019. https://www.rcplondon.ac.uk/guidelines-policy/strong-bones-after-50-fracture-liaison-services-explained (accessed 30 January 2023) Google ScholarRoyal Osteoporosis Society. Osteoporosis symptoms. 2022. https://theros.org.uk/information-and-support/osteoporosis/symptoms/ (accessed 30 January 2023) Google Scholar FiguresReferencesRelatedDetails 2 February 2023Volume 25Issue 2ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 11 February 2023 Published in print 2 February 2023 Information© MA Healthcare LimitedPDF download

Three-year outcomes of a fracture liaison service model at a university-based tertiary care hospital in Thailand

SummaryFragility hip fracture (FHF) is a serious complication of osteoporosis. A fracture liaison service (FLS) is crucial in preventing FHF. Our retrospective data of 489 patients with FHF and 3-year follow-ups demonstrated that the FLS improved functional outcomes. Our study’s mortality rates were lower than in other published series.PurposeThis study assessed the 3-year outcomes after fragility hip fracture (FHF) treatment by a multidisciplinary team from the Siriraj Fracture Liaison Service (Si–FLS). The review investigated the administration rates of anti-osteoporosis medication, refracture, and mortality; activities of daily living; mobility; and health-related quality of life.MethodsA retrospective review was performed of the records of Si-FLS patients given FHF treatment between June 2016 and October 2018. The outcomes were evaluated at 3 time points: before discharge, and 1 and 3 years after treatment.ResultsThe study enrolled 489 patients (average age, 78). The mortality and refracture rates at 1 year after hip fracture were 13.9% and 1.6%, respectively. At the 3-year follow-up, both rates were higher (20.4% and 5.7%, respectively). The Barthel Index and EuroQoL Visual Analogue Scale had risen to a plateau at the 1-year follow-up and remained stable to the 3-year follow-up. One year after treatment, approximately 60% of the patients could ambulate outdoors, and the proportion remained steady until the 3-year follow-up. There was no difference in the 1- and 3-year follow-up anti-osteoporosis medication administration rates (approximately 40%).ConclusionsThis study confirms the benefits of having a multidisciplinary FLS care team to manage older people with FHF. An FLS improves the care of patients with FHF and the social support of caregivers and relatives. The FLS maintained the functional outcomes of the patients through 3 years of postfracture treatment.

1282 EVALUATION OF THE IDENTIFICATION BONE HEALTH OF PATIENTS ON GERIATRIC WARDS

Abstract Introduction NICE guidelines state that fracture risk assessment should occur in all women aged ≥65 and all men aged ≥75. This includes assessing patients’ FRAX score, measuring serum vitamin D and calcium levels. Early detection and treatment can prevent complications like fragility fractures. We conducted a Quality Improvement Project to improve bone health assessments on Geriatric Wards. Methods A baseline audit assessed: admission reason, falls history, FRAX score, CFS, previous DEXA scans, whether vitamin D and calcium levels were checked during the admission, and if treatment was commenced (bone resorption medication and vitamin D/calcium supplements). Data was collected two further times following interventions over a 5-month period. The first intervention was an announcement at the morning departmental meeting reminding clinicians. The second intervention was an email reminder. Results There were 56, 51, and 58 patients per cycle. 19, 15, and 17 patients were admitted with falls. 23, 14, and 10 patients had a falls history. Average CFS was 5.4, 5.4, and 5.5. Average major osteoporotic fracture FRAX score was 15.8, 16.4, and 12.9. Checking serum calcium was 88%, 100%, and 100%. Checking vitamin D was 30%, 43%, and 60%. 28%, 43%, and 47% of patients were prescribed calcium and vitamin D supplements. Patients on bone resorptive treatment dropped from 7% to 3% to 2%. 8, 12, and 11 patients had a previous DEXA. Discussion Verbal announcement had the greatest impact. Visible reminders help sustainability. This QIP highlighted the lack of bone protection treatment with multiple contributing factors including some patients lacking the capacity to follow instructions to take weekly medications or patients requiring vitamin D being replaced initially, with initiation later. This QIP feeds into a larger trust project in developing a ‘Fracture Liaison Service’, which could improve adherence and provide a pathway in utilising annual and bi-annual treatments.

1289 INCREASING REFERRALS TO THE FRACTURE LIAISON SERVICE THROUGH IMPROVED MULTIDISCIPLINARY COMMUNICATION

Abstract Introduction The Fracture Liaison Service (FLS) is a multidisciplinary service for individuals over 50 presenting with fragility fractures. It is designed to assess future fracture risk, and appropriately diagnose and manage patients with osteoporosis.1 At Wrightington, Wigan and Leigh Teaching Hospitals (WWL), concerns were raised that access to this service was poor, meaning some patients presenting with fragility fractures were not receiving appropriate management to reduce risk of recurrent fracture. This project was designed to increase referrals to the service. Methods A cohort was identified of patients over 50 presenting to WWL with a fractured proximal humerus or distal radius/ulna over a three-month period from January to March 2021. These presentations were reviewed to identify the proportion of these patients who had been appropriately referred to the FLS. Following the initial audit, the FLS referral pathway was reviewed, and discussions were held with multidisciplinary teams (MDTs) in radiology and orthopaedic surgery to highlight the importance of appropriate bone health risk assessment. The number of patients referred each week by radiology were assessed before and after these discussions to assess whether access to the FLS had improved. Results In the initial audit 4.2% of patients with humeral fractures (n=24) and 0% of patients with radial/ulnar fractures (n=29) were appropriately referred to the FLS. Mean weekly referrals from radiology to the FLS significantly increased following the MDT discussions (mean 6.14, SD 4.40 vs mean 22, SD 6.38; t=6.71 p<0.001). Conclusions Pre-existing referral pathways to the FLS were found to be resulting in many patients not receiving appropriate care for their bone health. A simple review of referral pathways, and discussion with MDTs in other departments was found to be a simple way of improving access to the FLS and therefore hopefully reducing risk of fracture recurrence. Reference 1. https://theros.org.uk/media/1eubz33w/ros-clinical-standards-for-fracture-liaison-services-august-2019.pdf [Accessed 18.05.2022].

Approaches to organization of Fracture Liaison Services at the regional level with the involvement of primary care physicians

To prevent fractures which the elderly and the very old might deal with is a strategic task for preserving the life quality of the elderly and their independence from outside help, as well as reduce the health care and social support economic costs. The most effective and cost-effective organizational structure for reducing fractures frequency is the Fracture Liaison Service (FLS). The foundation of FLS at the regional level includes various models of these services, which is associated with a multi-level system of trauma care, different numbers of attached population and different number of specialists. Firstly, these are identification, assessment of clinical risk factors for osteoporosis, investigation for secondary osteoporosis causes and treatment initiation in the FLS with follow-up in the primary health care in 12–18 months’ time. Secondly, these are identification, risks assessment, patients’ investigation in the FLS during 3 months with the follow-up treatment initiating by the primary health care physician. And thirdly, these are assessment, investigation and treatment initiation by a primary care doctor immediately after trauma care. In any case of the FLS organization, a patient who has had a fragility fracture in any period after the fracture will be under the supervision of a primary care physician, and therefore additional efforts should be made by healthcare organizers, heads of a medical organization and other specialists in order to increase the identification of the patients with osteoporosis, their examination and treatment with anti-osteoporotic drugs in the primary health care. The article presents the results of the studies confirming the effectiveness of FLS with a coordinator, educational activities for patients and doctors, the role of a traumatologist in motivating a patient for examination and treatment, and other options to help a primary care physician with identifying, diagnosing and treating patients after fragility fractures.

Long-term follow-up of patients in fracture liaison services: problems and solutions (literature review and own data)

To reduce the frequency of fragility fractures, Fracture Liaison Services are being created worldwide. One of the most difficult parts in their organization is considered to be the creation of an effective system of long-term patient management. Many factors are involved in this process, concerning the patient, the team of specialist, the peculiarities of the organization of primary health care, and many others. On the one hand, it has been shown that the inclusion of patients in FLS increases their commitment to the implementation of doctor’s recommendations. On the other hand, there are a number of barriers depending both on the characteristics of the patient himself (polymorbidity, severity of the condition, decreased cognitive function, fear of side effects, low motivation to treat osteoporosis) and on various aspects in the medical care organization. The article analyzes the importance of training patients and medical personnel, approaches to the choice of therapeutic tactics, optimization of the process of succession management of patients, the availability of a system of information exchange between medical institutions. Using the example of the Yaroslavl’ FLS, the possibilities of improving various aspects of medical care are analyzed, as well as local problems that arose at various stages of the development of this service, and the measures that were applied to resolve them.

Comments on the use of Key Performance Indicators in evaluating the Organization of Fracture Liaison Services

In recent years Fracture Liaison Services (FLS) have been established worldwide to reduce the number of fractures due to osteoporosis. Within the framework of the global campaign «Capture the fracture» by International Osteoporosis Foundation (IOF), some questionnaires have been proposed to assess the quality of FLS’ organization. Key Performance Indicators (KPIs) are used to analyze the effectiveness of the FLS working at the patient level. Thanks to their use, it is possible to identify areas that need improvement, evaluate the effectiveness of the changes being made, and compare the quality of work in various FLS at the regional or country level. This article discusses approaches to the use and calculation of each KPI in practical healthcare in the Russian Federation, taking into account epidemiological data, national clinical guidelines, and the specifics of the organization of the healthcare system in our country.

Fracture liaison services creation is the key to decrease fragility fractures morbidity

Background . Fragility fractures (FF) determine main severity of medical and social consequences of osteoporosis. FF prophylaxis considers to prevent repeated fractures. For this reason special services are being created. Their principles and effectiveness require improvement and additional study. Aim . Тo highlight key role of Fracture Liaison Services (FLS) for reducing incidence of FF by means of scientific publications and own material analysis. Materials and methods . Clinical material was collected at the Artashat Medical Center (Republic of Armenia). Study included 2,332 patients aged 50–97 years, including 1,656 women (71%) and 676 men (29%) with typical FF of limb bones. First group included 765 patients treated in 2011–2013, for whom anti-osteoporotic pharmacotherapy (AP) was prescribed due to known X-ray techniques. In second group of 1567 patients the AP was prescribed based on electronic FRAX calculator in 2014–2017. Proportions of patients in two clinical groups with and without AP were compares along with proportions who had repeated low-energy bone fractures. Moreover, past 20 years scientific publications analysis dedicated to prevention of FF and role of FLS was carried out. Results . Comparative analysis revealed that patients proportion with prescribed AF based on use of FRAX calculator in second clinical group, significantly (p<0.05) increased by 16.6%, while patients proportion with repeated FF significantly (p<0.05) decreased by 6.5% (or 1.17 times) in relation to first group. Analysis of publications has shown high efficiency of FLS and their important role in reducing incidence of FF in general. Conclusion . Use of FRAX calculator for AP prescription allowed to achieve significant (p<0.05) increase by 16.6% in proportion with prescribed specific AP, which led to significant (p<0.05) decrease of patient proportion (6.5%) with repeated low-energy fractures. Analysis of scientific publications and own material confirmed key role of FLS for reducing the incidence of FF.

Osteoporosis care after hip fracture: Observation from national health insurance database and fracture liaison services

The objective of this research was to report the trend of osteoporosis care after hip fractures from usual care (UC) and to compare the quality of care with those who received fracture liaison services (FLSs). Data on osteoporosis care for patients with hip fracture were acquired from the National Health Insurance claims (UC group), and surveys from FLS programs (FLS group). A total of 183,300 patients receiving UC and 3010 patients receiving FLS were studied. For the two groups, common osteoporosis care indicators, such as bone mineral density (BMD) testing rate, antiosteoporosis medication commencement rate, and adherence rate were described. There were 2488 participants (82.7%) in the FLS group who completed Dual-energy X-ray absorptiometry (DXA) in 8 weeks, 155 (5.1%) who finished it between 8 weeks and 1 year. Even in 2018, when the DXA completion rate was at its highest, the completion rate in the UC group was only 23.5%. In terms of medication commencement, 2372 FLS patients (78.8%) received treatment within 3 months. Only 24.9% of the UC patients received antiosteoporosis medication within 3 months. Furthermore, antiosteoporosis medication adherence rate was 92.2% after 1 year and 83.9% after 2 years in the FLS group, but these were only 66.5% and 42.7%, respectively, in the UC group. Patients who received FLS had more timely BMD exams, antiosteoporosis medication treatment, and higher adherence to antiosteoporosis therapy than those who received UC. The discrepancy in rates of continuing treatment became more significant over time between both groups.

Follow-up and compliance to anti-osteoporotic treatment from nursing in a fracture liaison service

Follow-up and compliance to anti-osteoporotic treatment from nursing in a fracture liaison service

The role of the fracture liaison service in the prevention of atypical femoral fractures.

Osteoporosis and fragility fractures (FFs) are considered critical health problems by the World Health Organization (WHO) because of high morbidity, mortality, and healthcare costs. The occurrence of a FF raises the risk of a subsequent fracture (refracture). The hip is the most common site of fragility refracture, and its onset is associated with a further increase in patient's morbidity, mortality, and socioeconomic burden. Therefore, the prevention of refracture is essential. In this context, fracture liaison service (FLS) demonstrated to be able to reduce FF risk and also improve patients' adherence to anti-osteoporotic treatments, particularly for bisphosphonates (BPs). However, long-term and high adherence to BPs may lead to atypical femoral fractures (AFFs). These latter are tensile side stress fractures of the femur, with high rates of complications, including delayed and non-healing. An effective FLS should be able to prevent both FF and AFF. A comprehensive and interdisciplinary approach, through the involvement and education of a dedicated team of healthcare professionals (i.e. orthopedic, geriatrician, primary care physician, rehabilitation team, and bone nurse) for evaluating both FF and AFF risks might be useful to improve the standard of care.

Evaluation of mortality and morbidity associated with osteoporotic hip fracture

Introduction: Hip fractures in older adults are associated with significant morbidity, mortality, loss of independence, and financial burdens. In this study, we assessed how factors influenced these effects in elderly patients presenting with hip fractures. Materials and Method: A prospective observational study was conducted over six months on all patients with fall and hip fractures above 50 years of age who presented to the orthopedics and traumatology clinic of our university hospital. Ambulation status, time until operation, vitamin D level, vertebral fractures, Charlson comorbidity index, and Fracture Risk Assessment Tool score were recorded. The patients’ re-evaluated in the sixth month after the fracture. The relationship between death and risk factors was examined by regression analysis. Results:105 patients were included in the study. The mortality rate was 23.8%. The immobility rate also increased from before the operation to after 1.9% to 31.4%. Univariate regression analysis showed that mortality is related to age, Charlson comorbidity index, smoking history, and Fracture Risk Assessment Tool hip score. At the same time, multivariate regression analysis revealed an association between body mass index, smoking history, and mortality. Conclusion :Osteoporosis is a widespread disease that may remain hidden until complications, such as fractures, present themselves. Functional loss and mortality risk are high in patients with fractures. Age, Charlson comorbidity index, body mass index, smoking, Fracture Risk Assessment Tool hip score, and pre-fracture ambulation status affect mortality. A decrease in mortality can be achieved by monitoring risky individuals in fracture liaison services. Keywords: Risk factors; Mortality; Osteoporosis; Hip fractures.