A fracture prevention service reduces further fractures two years after incident minimal trauma fracture

Kallen, John Van der; Giles, Michelle; Cooper, Kerry; Gill, Kerry; Parker, Vicki; Tembo, Agness C; Major, Gabor; Ross, Linda; Carter, Jan

doi:10.1111/1756-185x.12101

Cited by 57 publications

(42 citation statements)

References 26 publications

(90 reference statements)

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“…Frail individuals could be targeted for interventions beyond routine management of CKD-MBD, such as home safety fall risk assessment, referral to physical therapy for gait or strength training, and careful evaluation for potential contribution of polypharmacy. Integrated secondary prevention measures of this type have been shown to significantly lower the risk of repeat falls [30, 31] and to reduce mortality by almost 50% in person over the age of 50 diagnosed with a minimal trauma fracture [32]. …”

Section: Discussionmentioning

confidence: 99%

Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis

Delgado

Shieh²,

Grimes

et al. 2015

Am J Nephrol

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Background: Although frailty has been linked to higher risk of falls and fracture in the general population, only few studies have examined the extent to which frailty is associated with these outcomes among patients with end-stage renal disease, who are at particularly high risk for these events. Methods: A total of 1,646 patients who were beginning maintenance hemodialysis in 297 dialysis units throughout the United States from September 2005 to June 2007 were enrolled in the Comprehensive Dialysis Study, and 1,053 Medicare beneficiaries were included in this study. Self-reported frailty was defined by the patients endorsing 2 or more of the following: poor physical functioning, exhaustion or low physical activity. Falls and fractures requiring medical attention were identified through Medicare claims data. We examined the association between frailty and the time to first fall or fracture using the Fine-Gray modification of Cox proportional hazards regression, adjusted for demographics, Quételet's body mass index, diabetes mellitus, heart failure and atherosclerosis. Results: Seventy-seven percent of patients were frail by self-report. The median length of follow-up was 2.5 (1.0-3.9) years. Crude rates of first medically urgent falls or fractures were 66 and 126 per 1,000 person-years in non-frail and self-reported frail participants, respectively. After accounting for demographic factors, comorbidities and the competing risk of death, self-reported frailty was associated with a higher risk of falls or fractures requiring medical attention (hazards ratio 1.60, 95% CI 1.16-2.20). Conclusion: Participants reporting frailty experienced nearly twice the risk of medically urgent falls or fractures compared to those who did not report frailty.

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Section: Discussionmentioning

confidence: 99%

Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis

Delgado

Shieh²,

Grimes

et al. 2015

Am J Nephrol

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“…Following this, similar services were set up in many countries, including Canada,22–24 the Netherlands,25,26 USA27–31 and Australia 32–34…”

Section: The Conception Of Fracture Liaison Servicesmentioning

confidence: 99%

“…Compared to either primary care follow-up or a comparable hospital without an FLS program, there was a significant reduction in subsequent fractures over 2–4 years following the index fracture in the FLS group (Table 1). 28,33,34,38–41…”

Section: Fls Outcomesmentioning

confidence: 99%

Fracture liaison services: improving outcomes for patients with osteoporosis

Walters

Khan

Ong

et al. 2017

CIA

123

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Fragility fractures are sentinels of osteoporosis, and as such all patients with low-trauma fractures should be considered for further investigation for osteoporosis and, if confirmed, started on osteoporosis medication. Fracture liaison services (FLSs) with varying models of care are in place to take responsibility for this investigative and treatment process. This review aims to describe outcomes for patients with osteoporotic fragility fractures as part of FLSs. The most intensive service that includes identification, assessment and treatment of patients appears to deliver the best outcomes. This FLS model is associated with reduction in re-fracture risk (hazard ratio [HR] 0.18–0.67 over 2–4 years), reduced mortality (HR 0.65 over 2 years), increased assessment of bone mineral density (relative risk [RR] 2–3), increased treatment initiation (RR 1.5–4.25) and adherence to treatment (65%–88% at 1 year) and is cost-effective. In response to this evidence, key organizations and stakeholders have published guidance and framework to ensure that best practice in FLSs is delivered.

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“…In addition, with these programs attaining longevity, additional studies have shown that they resulted in not only more treatment being initiated but also an extended time of treatment adherence 14,[18][19][20]22,29 . Further review also demonstrated that these programs decreased secondary fracture risk and even mortality over time 19,27,36,[38][39][40][41][42] . Importantly, with projected increases in fragility fractures and the associated burden to the health-care systems, the FLS has also been shown to be cost-effective in multiple studies 13,27,33,[42][43][44][45][46][47][48][49][50][51][52][53] .…”

Section: Programs For the Prevention Of Secondary Fracturesmentioning

confidence: 99%

Establishing a Fracture Liaison Service: An Orthopaedic Approach

Miller

Lake

Emory

2015

The Journal of Bone and Joint Surgery

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➤ Bone health evaluations should be incorporated into care pathways for fragility fractures in all patients who are fifty years of age or older.➤ A fracture liaison service (FLS) is an established and proven method to achieve recommended standards of care for fragility fractures, including intervention for osteoporosis, secondary fracture prevention, and bone health evaluation.➤ The FLS facilitates patient care by automatically including all patients with a fragility fracture within a health-care system to provide them with the intervention that they need and to prevent avoidable fracture-related complications or readmissions.➤ An FLS functions with three key personnel: the FLS coordinator (usually an advanced practice provider), a physician champion (usually an orthopaedic surgeon), and a nurse navigator.

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A fracture prevention service reduces further fractures two years after incident minimal trauma fracture

Abstract: Patients managed by a fracture prevention clinic service following a MTF have fewer new fractures and are more likely to be on treatment for bone fragility.

Cited by 57 publications

References 26 publications

Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis

Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis

Fracture liaison services: improving outcomes for patients with osteoporosis

Establishing a Fracture Liaison Service: An Orthopaedic Approach

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