Secondary Fracture Prevention Research Articles

Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

Efficacy and safety of osteoporosis treatment in older adults. approach for the secondary prevention of fractures in older populations. a proposal by SEFRAOS

Efficacy and safety of osteoporosis treatment in older adults. approach for the secondary prevention of fractures in older populations. a proposal by SEFRAOS

Impact of the guidance on fracture Liaison Services and the introduction of a new fee for secondary fracture prevention in Japan: Implementation of secondary fracture prevention during hospitalization for fragility fractures.

Secondary fracture prevention is important for managing fragility fractures. In Japan, the FLS-CS was published in 2019, alongside the introduction of a new management fee for secondary fracture prevention, launched in 2022 for patients who underwent surgery for hip fracture. FLS programs were hospital-based. This study evaluated the impact of these interventions on the implementation of secondary fracture prevention during hospitalization for fragility fractures. Using claims data from the Quality Indicator/Improvement Project database, patients aged 50years or older with hip fracture who underwent surgery or with vertebral fractures were included. The publication of FLS-CS was the first intervention, followed by the introduction of the management fee as the second intervention. To evaluate the impact of these interventions, we performed an interrupted time series analysis separately for hip and vertebral fractures. For hip fractures, there was no immediate change after the first intervention, and the monthly rate of change decreased (incidence rate ratio [IRR]: 0.985, 95% confidence interval [CI]: 0.979-0.991). After the second intervention, there was an immediate increase (IRR: 1.890, 1.761-2.029), and the monthly rate of change also increased (IRR: 1.050, 1.044-1.056). For vertebral fractures, the proportion of change increased only immediately after the second intervention (IRR: 1.148, 1.038-1.270). The publication of FLS-CS had no apparent effect on the implementation of secondary fracture prevention in patients with either hip or vertebral fractures. Conversely, the introduction of the management fee had the effect of increasing that for the target disease.

Actions to Improve the Secondary Prevention of Fragility Fractures in Women with Postmenopausal Osteoporosis: A Social Return on Investment (SROI) Study.

This study evaluates the Social Return on Investment (SROI) of implementing measures to prevent fragility fractures in postmenopausal women with osteoporosis (OP) in Spain. A group of 13 stakeholders identified necessary actions for improving refracture prevention and assessed the investment required from the Spanish National Health System (SNHS), considering direct, indirect, and intangible costs over a one-year period. Unitary costs were sourced from scientific literature and official data, and intangible costs were estimated through surveys on women's willingness to pay for better health-related quality of life. The SROI ratio was calculated from both a social perspective (including all returns) and the SNHS perspective (including only direct and intangible costs). A sensitivity analysis evaluated the returns in worst- and best-case scenarios over three years. Stakeholders agreed on four main actions: 1) establishing fracture liaison services; 2) harmonizing clinical practice guidelines and provide training for healthcare professionals (HCPs); 3) promoting HCPs' adherence to fracture registries and 4) raising awareness of OP and fragility fractures. From the social perspective, implementing these actions would cost the SNHS €4,375,663 but yield a social return of €96,939,931 in the first year, resulting in a SROI ratio of €22.15 per euro invested (€28.69, 23.14, 24.29, and 10.70 for the four actions, respectively). From the SNHS perspective, the return would be €36,453,509 (€21,523,444 tangible), with a SROI of €8.33 (€4.92 tangible) and for the four actions: €9.99, 9.39, 8.45, and 3.79, respectively (€5.89, 5.54, 4.96 and 2.27 tangible). The investment would be lower than the return for all actions (3.49%, 4.32%, 4.12% and 9.34% of social perspective return, respectively) and scenarios. According to our SROI method, implementing different actions to improve secondary fracture prevention would achieve a considerable social benefit, which, in terms of direct, indirect, and intangible costs, would far outweigh the investment.

7334 Changing Trends In Oral Bisphosphonate Therapy: A 25-Year Surveillance In A US Healthcare System

Abstract Disclosure: J.C. Lo: None. M. Chandra: None. M.M. Khan: None. L.D. Carbone: None. E.A. Garcia: None. G.H. Tabada: None. D. Low: None. R.L. Hui: None. Introduction: Bisphosphonate (BP) drugs remain one of the first line therapies for fracture prevention, but treatment patterns have changed since BPs were first approved for osteoporosis. This study examines trends among adults initiating oral BP in a large US healthcare system over a 25-year period (1988-2022) and in each successive 5-year period. Methods: The study cohort comprised adults aged 50-89y who initiated alendronate, risedronate or oral ibandronate during 1998-2022 in an integrated healthcare delivery system, excluding those with select bone disorders, multiple myeloma, secondary metastatic cancer, end stage renal disease, and receipt of intravenous BP. Covariates included age (proportion age <65y), sex, race and ethnicity, and prior fracture (diagnosed within 5 years) using electronic health record data. Demographic trends and fracture status were examined across time periods. The chi-squared test and Cochrane-Armitage test for trend were used to examine differences and trends. This report extends findings from an earlier report of women initiating oral BP during 2004-2012 in the same healthcare population. Results: Among 208,780 adults (86% women) who initiated BP, including 26,646 (1998-2002, 35% <65y), 44,726 (2003-2007, 35% <65y), 34,005 (2008-2012, 24% <65y), 35,248 (2013-2017, 19% <65y), and 38,743 (2018-2022, 17% <65y) women and 2348 (1998-2002, 28% <65y), 4895 (2003-2007, 26% <65y), 5172 (2008-2012, 17% <65y), 5331 (2013-2017, 13% <65y), and 11,666 (2018-2022, 5% <65y) men in each 5-year period. Over time, an increasing proportion were age ≥65y (p<0.001 for trend), with larger numbers of older adults in later years partly reflecting initiatives targeting secondary fracture prevention (since 2008 for women, 2015 for men) and BMD screening (since 2011 for women, 2017 for men). Among women initiating BP, the proportion with prior fracture increased from 24-30% (pre-2008) to 43-45% (post-2008), partly reflecting secondary fracture prevention initiatives for women. For men, this proportion increased from 33% (1998-2002) to 42% (2003-2007), 47% (2008-2012), and 54% (2013-2017), but fell to 36% (2018-2022) after BMD screening initiatives began in 2017 for older men (primary prevention efforts). Racial and ethnic diversity in treatment also increased, comparing 1988-2002 (75.2% White, 2.5% Black, 8.6% Hispanic, 12.7% Asian/Pacific Islander) to 2018-2022 (61.5% White, 2.9% Black, 12.2% Hispanic, 21.1% Asian/Pacific Islander, p<0.001 for overall differences and % non-White). Conclusions: In a primary care population of adults initiating oral BP, a larger proportion in later years were age >65y, including larger numbers both with and without fracture coinciding with initiatives for fracture prevention. Among those initiating BP, the relative proportions with prior fracture in each period were likely influenced by primary or secondary prevention efforts. Presentation: 6/2/2024

9212 Changing Trends In Oral Bisphosphonate Therapy: A 25-Year Surveillance In A US Healthcare System

Abstract Disclosure: J.C. Lo: None. M. Chandra: None. M.M. Khan: None. L.D. Carbone: None. E.A. Garcia: None. G.H. Tabada: None. D. Low: None. R.L. Hui: None. Introduction: Bisphosphonate (BP) drugs remain one of the first line therapies for fracture prevention, but treatment patterns have changed since BPs were first approved for osteoporosis. This study examines trends among adults initiating oral BP in a large US healthcare system over a 25-year period (1988-2022) and in each successive 5-year period. Methods: The study cohort comprised adults aged 50-89y who initiated alendronate, risedronate or oral ibandronate during 1998-2022 in an integrated healthcare delivery system, excluding those with select bone disorders, multiple myeloma, secondary metastatic cancer, end stage renal disease, and receipt of intravenous BP. Covariates included age (proportion age <65y), sex, race and ethnicity, and prior fracture (diagnosed within 5 years) using electronic health record data. Demographic trends and fracture status were examined across time periods. The chi-squared test and Cochrane-Armitage test for trend were used to examine differences and trends. This report extends findings from an earlier report of women initiating oral BP during 2004-2012 in the same healthcare population. Results: Among 208,780 adults (86% women) who initiated BP, including 26,646 (1998-2002, 35% <65y), 44,726 (2003-2007, 35% <65y), 34,005 (2008-2012, 24% <65y), 35,248 (2013-2017, 19% <65y), and 38,743 (2018-2022, 17% <65y) women and 2348 (1998-2002, 28% <65y), 4895 (2003-2007, 26% <65y), 5172 (2008-2012, 17% <65y), 5331 (2013-2017, 13% <65y), and 11,666 (2018-2022, 5% <65y) men in each 5-year period. Over time, an increasing proportion were age ≥65y (p<0.001 for trend), with larger numbers of older adults in later years partly reflecting initiatives targeting secondary fracture prevention (since 2008 for women, 2015 for men) and BMD screening (since 2011 for women, 2017 for men). Among women initiating BP, the proportion with prior fracture increased from 24-30% (pre-2008) to 43-45% (post-2008), partly reflecting secondary fracture prevention initiatives for women. For men, this proportion increased from 33% (1998-2002) to 42% (2003-2007), 47% (2008-2012), and 54% (2013-2017), but fell to 36% (2018-2022) after BMD screening initiatives began in 2017 for older men (primary prevention efforts). Racial and ethnic diversity in treatment also increased, comparing 1988-2002 (75.2% White, 2.5% Black, 8.6% Hispanic, 12.7% Asian/Pacific Islander) to 2018-2022 (61.5% White, 2.9% Black, 12.2% Hispanic, 21.1% Asian/Pacific Islander, p<0.001 for overall differences and % non-White). Conclusions: In a primary care population of adults initiating oral BP, a larger proportion in later years were age >65y, including larger numbers both with and without fracture coinciding with initiatives for fracture prevention. Among those initiating BP, the relative proportions with prior fracture in each period were likely influenced by primary or secondary prevention efforts. Presentation: 6/2/2024

Estimating Patient Eligibility And Benefit Of Intravenous Zolendronic Acid In Hip Fracture Patients: A Service Evaluation

Abstract Background Low trauma hip fractures are serious and carry an estimated re-fracture rate of 10.6%, leading increased morbidity, mortality and healthcare cost. Intravenous Zolendronic Acid (IVZ) administration following hip fracture reduces re-fracture risk by approximately 23% and is recommended yearly for three years by National Osteoporosis Guidelines Group (NOGG) 2021. However, a significant treatment gap remains with only one-fifth of patients receiving IVZ pre-discharge, due to implementation challenges, such as suboptimal Vitamin D levels and lack of resources for yearly infusions. Recently published consensus guidelines offer practical advice as to how to overcome these barriers. This service evaluation estimates the proportion of hip fracture patients eligible for IVZ; as well as the re-fracture rate, prior to the introduction of a local IVZ pathway. Methods Approval from local Quality and Patient Safety Department was received. Low trauma hip fracture patients were identified from the local Orthogeriatric database (October 2019 to January 2021). Hospital electronic laboratory and radiology software were used to identify renal function on discharge and evidence of further fractures (at six months, 1 year and 3 years). Subjects were deemed potentially eligible for IVZ if they had an estimated glomerular filtration rate (eGFR) of ≥50 mls/min (a proxy for calculated creatinine clearance ≥30mls/min in this patient cohort). Results Of 463 subjects, 384 (82.9%) had an eGFR ≥50. Re-fracture data was collected for 263 eligible subjects. Seventeen (6.5%) re-fractured within six months, 21 (8%) re-fractured within a year and 45 (17.1%) re-fractured at any stage post discharge. Conclusion IVZ treatment is the most efficacious secondary fracture prevention post-hip fracture, and most patients are eligible for this treatment. Implementing IVZ pathways for hip fracture patients may significantly reduce re-fracture rate, however expansion of resources allocated to Orthogeriatrics and Fracture Liaison teams is required to successfully implement inpatient pathways and ongoing care.

Integrated model of secondary fracture prevention in primary care (INTERCEPT): protocol for a cluster randomised controlled multicentre trial

BackgroundOsteoporotic fractures signal severely compromised bone strength and are associated with a greatly increased risk of refracture. Despite the availability of effective and safe medications that reduce fracture risk, 70–80% of patients are inadequately investigated or treated for osteoporosis following an initial fracture, constituting a significant ‘osteoporosis care gap’. Optimal methods of bridging this gap with primary care at the forefront of secondary fracture prevention remain undetermined. This protocol describes a cluster randomised controlled trial to evaluate the effectiveness of a novel integrated model of secondary fracture prevention and management in primary care.MethodsThe cluster randomised controlled trial involves multiple branches of a community-based radiology provider (CRP), a hospital-based secondary fracture prevention program (SFPP) and numerous primary care practices in metropolitan Sydney that refer to either the CRP or SFPP. Using natural language processing tools, patients diagnosed with a potential osteoporotic fracture will be identified by automatically screening radiology reports generated at the CRP or SFPP. The primary care practices that these patients attend will be randomised (1:1) to either the intervention or usual care. The intervention consists of (i) electronic and fax alerts informing the practice/primary care physician that their patient has been diagnosed with a potential osteoporotic fracture; (ii) provision of osteoporosis management guidelines and (iii) follow-up surveys at 4 weeks and 6 months. Practices in the usual care (control) group will receive no alerts and provide usual care. The primary outcome is the proportion of patients undergoing a bone density scan and/or filling a prescription for osteo-protective pharmacotherapy within 3 months of the initial diagnostic imaging report. Secondary outcomes are the proportion of patients: (i) undergoing an osteoporosis-related blood test within 3 months of the initial diagnostic imaging report; (ii) initiated on a chronic disease management plan within 3 months of the diagnostic report, and (iii) filling a second prescription for osteo-protective pharmacotherapy within 9 months post initial diagnostic imaging report. Outcomes will be obtained through de-identified linked data from Medical Benefits Schedule and Pharmaceutical Benefits Scheme held by the Australian Institute of Health and Welfare.DiscussionThis is the first randomised trial to integrate case-detection of potential osteoporotic fractures in a hospital and community setting with direct alerts to the patient’s primary care provider. This study will determine whether such an intervention is effective in improving investigation and/or treatment rates of osteoporosis in patients with a potential osteoporotic fracture.Trial registrationThis study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000658617p.

A Bone Health Optimization Framework for Malaysia: a position paper by the Malaysian Bone Health Optimization Network (MyBONe).

Osteoporosis and osteopenia are highly prevalent among older patients scheduled for elective arthroplasties and spinal surgeries. This position paper aims to establish, promote, and standardise effective Bone Health Optimization (BHO) strategies for such patients within orthopaedic practices in Malaysia. It emphasises the need for bone health assessments to be undertaken at the pre-operative, intra-operative, and post-operative stages, with tailored management strategies to meet individual patient needs. A comprehensive literature review was conducted, focusing on articles published from 2019 to 2024. Twelve broad themes were defined including definitions and importance of BHO, epidemiological data, assessment techniques, risk stratification, management strategies, and outcome metrics. Elective surgeries on patients with poor bone health are associated with adverse outcomes, such as periprosthetic fractures, aseptic loosening of implants, and complications after spinal surgeries. This position paper advocates for routine bone health assessments and monitoring during the pre-operative, intra-operative, and post-operative phases. It provides summaries of imaging modalities, risk assessment tools, and techniques for each phase. By adapting the successful "5IQ" approach from secondary fracture prevention, we propose 5IQ-based Clinical Standards for BHO, including 18 Key Performance Indicators. A Malaysian BHO Registry is proposed to benchmark care in real-time and support a national quality improvement programme. Practical resources, such as a BHO algorithm and key practice points, are included. This position paper proposes a paradigm shift in the management of bone health for patients undergoing elective orthopaedic surgery in Malaysia, aiming to improve surgical outcomes and patient care through standardised BHO strategies.

The Fracture Phenotypes in Women and Men of 50 Years and Older with a Recent Clinical Fracture.

We review the literature about patients 50 years and older with a recent clinical fracture for the presence of skeletal and extra-skeletal risks, their perspectives of imminent subsequent fracture, falls, mortality, and other risks, and on the role of the fracture liaison service (FLS) for timely secondary fracture prevention. Patients with a recent clinical fracture present with heterogeneous patterns of bone-, fall-, and comorbidity-related risks. Short-term perspectives include bone loss, increased risk of fractures, falls, and mortality, and a decrease in physical performance and quality of life. Combined evaluation of bone, fall risk, and the presence of associated comorbidities contributes to treatment strategies. Since fractures are related to interactions of bone-, fall-, and comorbidity-related risks, there is no one-single-discipline-fits-all approach but a need for a multidisciplinary approach at the FLS to consider all phenotypes for evaluation and treatment in an individual patient.

Trends in hip fracture rates in US male veterans.

In the United States, the annual incidence of osteoporotic hip fracture is estimated to be 250,000 to 300,000; the one-year mortality in some studies has been as high as 32%. Reports that hip fracture rates in US women 65years and older may no longer be declining led to this investigation of hip fracture in men, a less studied population. We assessed the trends in the incidence of hip fracture in US male veterans 50years and older of age as well as the rates of diagnosis and treatment in such men. We assessed the recent trends of hip fracture incidence in a nation-wide male veteran population 50years and older of age. Using data from the US Veterans Affairs Informatics and Computing Infrastructure (VINCI) 2002-2019, we calculated the annual age-standardized hip fracture incidence. Secondary objectives included evaluating the annual proportion of hip fracture patients who underwent dual-energy X-ray absorptiometry (DXA) before or after the fracture and/or received osteoporosis medication after the hip fracture over the study period. Hip fracture incidence increased in male veterans from 2006 to 2019. Fewer than 6% of men underwent a DXA scan and fewer than 0.5% received osteoporosis medications up to two years after a hip fracture. Despite available screening methods such as DXAs and medications for primary and secondary prevention of osteoporotic fractures, hip fracture incidence is not decreasing in older male veterans. Our study highlights a need for closerattention to fracture risk in men.

Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis.

This systematicreview seeks to evaluate the proportion of fragility fracture patients screened in secondary fracture prevention programs who were indicated for pharmacological treatment, received prescriptions for bone-active medications, and initiated the prescribed medication. Additionally, the study aims to analyze equity in pharmacological treatment by examining equity-related variables including age, sex, gender, race, education, income, and geographic location. We conducted a systematic review to ascertain the proportion of fragility fracture patients indicated for treatment who received prescriptions and/or initiated bone-active medication through secondary fracture prevention programs. We also examined treatment indications reported in studies and eligibility criteria to confirm patients who were eligible for treatment. To compute the pooled proportions for medication prescription and initiation, we carried out asingle group proportional meta-analysis. We also extracted the proportions of patients who received aprescription and/or began treatment based on age, sex, race, education, socioeconomic status, location, and chronic conditions. This review included 122 studies covering 114 programs. The pooled prescription rate was 77%, and the estimated medication initiation rate was 71%. Subgroup analysis revealed no significant difference in treatment initiation between the Fracture Liaison Service and other programs. Across all studies, age, sex, and socioeconomic status were the only equity variables reported in relation to treatment outcomes. Our systematic review emphasizes the need for standardized reporting guidelines in post-fracture interventions. Moreover, considering equity stratifiers in the analysis of health outcomes will help address inequities and improve the overall quality and reach of secondary fracture prevention programs.

The Orthopedic Upper Extremity Surgeon's Role in the Diagnosis and Treatment of Osteoporosis: Making Use of Opportunistic Imaging.

Osteoporosis is an underdiagnosed and undertreated public health issue that contributes to a high financial burden on the healthcare system and imposes significant morbidity and mortality on the patient population. Upper extremity orthopedic surgeons are in a unique position to diagnose osteoporosis prior to patients suffering a fragility fracture by using imaging that they already obtain in their current workflow. The use of X-rays and CT scans can effectively diagnose osteoporosis with high sensitivity and specificity. By incorporating these diagnostic methods into standard practice, upper extremity orthopedic surgeons can play a critical role in the early diagnosis and treatment of osteoporosis. This can prevent severe fractures, improve patient outcomes, and reduce the overall healthcare burden by initiating timely treatment and patient education. This review emphasizes the importance of opportunistic imaging in enhancing osteoporosis management and suggests that upper extremity surgeons can significantly and effectively contribute to primary and secondary fracture prevention.

Subsequent fracture risk in Norwegians and immigrants with an index forearm fracture: a cohort study

SummaryThe current study investigated subsequent fracture risk following a forearm fracture in three country of birth categories: Norway, Europe and North America, and other countries. Subsequent fracture risk was modestly higher in Norwegian-born individuals compared to the two other groups. Secondary fracture prevention should be recommended regardless of country background.BackgroundFracture risk is higher in patients with a previous fracture, but whether subsequent fracture risk differs by origin of birth is unknown. This study explores subsequent fracture risk in patients with an index forearm fracture according to region of birth.MethodsNationwide data on forearm fractures in patients ≥ 18 years in 2008–2019 were obtained from the Norwegian Patient Registry and Statistics Norway. Index fractures were identified by ICD-10 code S52, whereas subsequent fractures included any ICD-10 fracture code. Data on country of birth were from Statistics Norway and included three regional categories: (1) Norway, (2) other Europe and North America and (3) other countries. Direct age standardization and Cox proportional hazard regression were used to analyse the data.ResultsAmong 143,476 individuals with an index forearm fracture, 35,361 sustained a subsequent fracture. Norwegian-born forearm fracture patients had the highest subsequent fracture rates (516/10,000 person-years in women and 380 in men). People born outside Europe and North America had the lowest rates (278/10,000 person-years in women and 286 in men). Compared to Norwegian-born individuals, the hazard ratios (HRs) of subsequent fracture in individuals from Europe and North American were 0.93 (95% CI 0.88–0.98) in women and 0.85 (95% CI 0.79–0.92) in men. The corresponding HRs in individuals from other countries were 0.76 (95% CI 0.70–0.84) in women and 0.82 (95% CI 0.74–0.92) in men.ConclusionIndividuals born outside Norway had a lower subsequent fracture risk than Norwegian-born individuals; however, subsequent fracture risk increased with age in all groups. Our results indicate that secondary fracture prevention should be recommended regardless of region of origin.

Following hip fracture, hospital organisational factors associated with prescription of anti-osteoporosis medication on discharge, to address imminent refracture risk: a record-linkage study.

Patients who sustain a hip fracture are known to be at imminent refracture risk. Their complex multidisciplinary rehabilitation needs to include falls prevention and anti-osteoporosis medication (AOM) to prevent such fractures. This study aimed to determine which hospital-level organisational factors predict prescription of post-hip fracture AOM, and refracture risk. A cohort of 178 757 patients aged ≥60years who sustained a hip fracture in England and Wales (2016-19) was examined and followed for 1year. Patient-level hospital admission datasets from 172 hospitals, the National Hip Fracture Database, and mortality data were linked to 71 metrics extracted from 18 hospital-level organisational reports. Multilevel models determined organisational factors, independent of patient case-mix, associated with (i) AOM prescription, (ii) refracture (by ICD10 coding). Patients were mean (SD) 82.7 (8.6) years old, 71% female, with 18% admitted from care homes. Overall, 101 735 (57%) were prescribed AOM during admission; while 50 354 (28%) died during 1-year follow-up, 12 240 (7%) refractured. Twelve organisational factors were associated with AOM prescription, e.g., orthogeriatrician-led care compared to traditional care models (OR 4.65 [95%CI: 2.25-9.59]); AOM was 9% (95%CI: 6%-13%) more likely to be prescribed in hospitals providing routine bone health assessment to all patients. Refracture occurred at median 126days (IQR 59-234). Eight organisational factors were associated with refracture risk; hospitals providing orthogeriatrician assessment to all patients within 72-hours of admission had an 18% (95%CI: 2-31%) lower refracture risk, weekend physiotherapy provision an 8% (95%CI: 3-14%) lower risk, and where occupational therapists attended clinical governance meetings, a 7% (95%CI: 2-12%) lower risk. Delays initiating post-discharge community rehabilitation were associated with a 15% (95%CI: 3-29%) greater refracture risk. These novel, national findings highlight the importance of orthogeriatrician, physiotherapist and occupational therapist involvement in secondary fracture prevention post hip fracture; notably fracture risk reductions were seen within 12months of hip fracture.

Global current research status and future hotspots in osteoporotic fracture based on bibliometric assessment and visualization techniques.

In the past decade, the evolution of themes in the field of osteoporotic fractures has changed from epidemiology and prediction of long-term morbidity, risk assessment of osteoporotic fractures, and zoledronic acid and denosumab in the treatment of osteoporosis to treatment guidelines for osteoporosis and the side effects caused by anti-osteoporotic drugs. To understand the trends and hotspots in osteoporotic fracture research. Original articles were retrieved between January 1, 2010, and December 31, 2019, from the Web of Science Core Collection database. CiteSpace software facilitated the analysis and visualization of scientific productivity and emerging trends. Nine studies were identified using bibliometric indices, including citation, centrality, and sigma value, which might indicate a growing trend. Through clustering, we identified six major hot subtopics. Using burst analysis, top-5 references with the strongest bursting strength after 2017 were identified, indicating a future hotspot in this field. Current hot subtopics in osteoporotic fracture research include atypical femoral fractures, androgen deprivation therapy, denosumab discontinuation, hip fractures, trabecular bone score (TBS), and bone phenotype. Management and prevention of secondary fractures in patients with osteoporotic fractures, TBSs, and long-term administration strategy for zoledronic acid are expected to become research hotspots.

Taking care of inpatients with fragility hip fractures: the hip-padua osteosarcopenia (Hip-POS) fracture liaison service model.

Osteoporotic fragility fractures (FF), particularly those affecting the hip, represent a major clinical and socio-economic concern. These fractures can lead to various adverse outcomes, which may be exacerbated by the presence of sarcopenia, especially among older and frail patients. Early identification of patients with FF is crucial for implementing effective diagnostic and therapeutic strategies to prevent subsequent fractures and their associated consequences. The Hip-POS program, implemented at Azienda Ospedale-Università Padova, is a Fracture Liaison Service (FLS) program to evaluate patients aged > 50years old admitted with fragility hip fractures, involving an interdisciplinary team. After the identification of patients with hip fractures in the Emergency Department, a comprehensive evaluation is conducted to identify risk factors for further fractures, and to assess the main domains of multidimensional geriatric assessment, including muscle status. Patients are then prescribed with anti-fracture therapy, finally undergoing periodic follow-up visits. During the first five months, a total of 250 patients were evaluated (70.4% women, median age 85years). Following assessment by the Hip-POS team, compared to pre-hospitalization, the proportion of patients not receiving antifracture therapy decreased significantly from 60 to 21%. The prescription rates of vitamin D and calcium increased markedly from 29.6% to 81%. We introduced the Hip-POS program for the care of older adults with hip fractures. We aspire that our model will represent a promising approach to enhancing post-fracture care by addressing the multifactorial nature of osteoporosis and its consequences, bridging the gap in secondary fracture prevention, and improving patient outcomes.

Introduction of an order set after hip fracture improves osteoporosis medication initiation and persistence: a population-based before-after analysis.

A treatment gap exists after osteoporosis-related fractures. Introducing standardized care can improve treatment. We evaluated the impact of a hip fracture order set (OS) on anti-osteoporosis medication (AOM) initiation, persistence, and secondary fracture prevention. In 2015, one hospital in Manitoba, Canada, introduced a hip fracture OS including recommendations for the initiation of AOM (OS group). A control group was identified from the other hospitals in the same region. A retrospective cohort study was conducted using linked administrative health data. All individuals 50 + years with surgical treatment for low-energy hip fracture between 2010 and 2019 were included and followed for AOM initiation, medication persistence at 1year, and secondary fractures. Between-group differences for each year were assessed using chi-square tests. Logistic regression models tested the impact of socio-demographic and clinical factors on initiation, persistence of AOM. Cox regression tested the risk of secondary fracture. No baseline differences between OS group (813 patients) and control group (2150 patients) were observed in demographics, socioeconomic factors, or comorbidities. An increase in post-fracture AOM initiation was seen with OS introduction (OS group year before 16.7% versus year after 48.6%, p < 0.001). No change was seen in the control group. Persistence on AOM also increased (OS group year before 17.7% versus year after 28.4%, p < 0.001). No difference in secondary fractures was observed (OS group 19.8% versus control group 18.8%, p = 0.38). Introduction of a hip fracture OS significantly increased AOM initiation and persistence at 1-year post-fracture. There was no significant difference in secondary fractures.

A novel case-finding strategy based on artificial intelligence for the systematic identification and management of individuals with osteoporosis or at varying risk of fragility fracture.

Osteoporotic fractures represent a major cause of morbidity and, in older adults, a precursor of disability, loss of independence, poor quality of life and premature death. Despite the detrimental health impact, osteoporosis remains largely underdiagnosed and undertreated worldwide. Subjects at risk for osteoporosis-related fractures are identified either via organised screening or case finding. In the absence of a population-based screening policy, subjects at high risk of fragility fractures are opportunistically identified when a fracture occurs or because of other clinical risk factors (CRFs) for osteoporotic fracture and areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA). This paper describes the development of a novel case-finding strategy, named Osteoporosis Diagnostic and Therapeutic Pathway (ODTP), which enables to identify subjects with osteoporosis or at varying risk of fragility fracture. This strategy is based on a specifically designed software tool, named "Bone Fragility Query" (BFQ), which analyses the electronic health record (EHR) databases of General Practitioners (GPs) to systematically identify individuals who should be prescribed DXA-BMD measurement, vertebral fracture assessment (VFA) and anti-osteoporosis medications (AOM). The ODTP through BFQ tool is a feasible, convenient and time-saving osteoporosis model of care for GPs during routine clinical practice. It enables GPs to shift their focus from what to do (clinical guidelines) to how to do it in the primary health care setting. It also allows a systematic approach to primary and secondary prevention of fragility fractures, thereby overcoming clinical inertia and contributing to closing the gap between evidence and practice for the management of osteoporosis in primary care.

Secondary fracture prevention in Spanish primary care: results of the PREFRAOS Study

SummaryThis study demonstrated a large treatment gap in elderly subjects experiencing fragility fracture in Spanish primary care, a low treatment persistence among subjects who do receive treatment, and more than one-quarter having no follow-up visits post-fracture. These data highlight the need to improve secondary fracture prevention in primary care.PurposeTo describe osteoporosis (OP) treatment patterns and follow-up in subjects with fragility fracture seen in Spanish primary care (PC).MethodsThis observational, retrospective chart review included subjects aged ≥ 70 years listed in the centers' records (November 2018 to March 2020), with ≥ 1 fragility fracture and prior consultation for any reason; subjects who had participated in another study were excluded. Outcomes included OP treatments and follow-up visits post-fragility fracture.ResultsOf 665 subjects included, most (87%) were women; overall mean (SD) age, 82 years. Fewer than two thirds (61%) had received any prior OP treatment (women, 65%; men, 38%); of these, 38% had received > 1 treatment (women, 25%; men, 13%). Among treated subjects, the most frequent first-line treatments were alendronate (43%) and RANKL inhibitor denosumab (22%), with a higher discontinuation rate and shorter treatment duration observed for alendronate (discontinuation, 42% vs 16%; median treatment duration, 2.5 vs 2.1 years). Over one-quarter (26%) of subjects had no follow-up visits post-fragility fracture, with this gap higher in women than men (35% versus 25%). The most common schedule of follow-up visits was yearly (43% of subjects with a fragility fracture), followed by half-yearly (17%) and biennial (10%), with a similar trend in men and women. Most OP treatments were prescribed by PC physicians, other than teriparatide and zoledronate.ConclusionsAcross Spanish PC, we observed a large gap in the treatment and follow-up of elderly subjects experiencing a fragility fracture. Our data highlights the urgent need to improve secondary fracture prevention in PC.