A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network

Javaid, Muhammad Kassim; Sami, A; Lems, Willem F.; Mitchell, P. J.; Thomas, Thierry; Singer, Andrea; Speerin, Robyn; Fujita, Masaki; Pierroz, Dominique D.; Åkesson, Kristina; Halbout, Philippe; Ferrari, Serge; Cooper, Cyrus

doi:10.1007/s00198-020-05377-1

Cited by 77 publications

(66 citation statements)

References 70 publications

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“…A meta-analysis calculated that 20 patients would need to be treated to prevent one refracture within three years [ 24 ]. The indicators for measuring the impact of our program's implementation were based on those stipulated by the IOF/FFN/NOF [ 25 ]. However, given the short time, it has been in operation, and they have not yet revealed the expected impact according to the literature.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Postfracture Care Program in a Private Hospital in Colombia

Sánchez

Segura

Alajmo

et al. 2020

Journal of Osteoporosis

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Purpose. To describe the implementation of a postfracture care program in a private hospital in Colombia, the results achieved after the program’s first year, and the challenges encountered. Methods. A cross-sectional descriptive study of the first year’s outcomes. The program was implemented following best practices described in the “Capture the Fracture” framework. We assessed the management of fractures before the launch of the program. A multidisciplinary group was established to collaborate on the diagnosis and treatment of patients with osteoporotic fractures. A full-time program coordinator was appointed. We analyzed the program’s clinical outcomes and limitations. Results. One-hundred and ninety patients were included in the study, with an average age of 76.7. Hip fracture was the most frequent one (33.6%). After the first year of implementing the program, 39.4% of patients received osteoporosis treatment, with an adherence rate of 73%. The incidence of subsequent falls was 5.8% and 1% for new fractures. Conclusions. The implementation of a program for patients’ care with fragility fractures is challenging for healthcare institutions. The role of a full-time coordinator is critical for the proper operation of such programs.

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Section: Discussionmentioning

confidence: 99%

Implementation of a Postfracture Care Program in a Private Hospital in Colombia

Sánchez

Segura

Alajmo

et al. 2020

Journal of Osteoporosis

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“…Strategies to overcome this profound gap could include training for radiology trainees and specialists under vertebral fracture educational programs provided for by international organizations such as the ISCD and IOF. Furthermore, the importance of vertebral fractures is clearly recognized within the IOF/FFN/NOF patient level key performance indicators for FLS [124]. These studies illustrate that detecting prevalent vertebral fractures in patients with fragility fractures may help to close or at the very least narrow the care gap in fracture care [125,126].…”

Section: Discussionmentioning

confidence: 88%

Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services

et al. 2021

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Summary Vertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS. Summary points • Vertebral fracture assessment is a tool available on modern DXA instruments and has proven ability to detect vertebral fractures, the majority of which occur without a fall and without the signs and symptoms of an acute fracture. • Most osteoporosis guidelines internationally suggest that treatment with antiosteoporosis medications should be considered for older individuals (e.g., 65 years +) with a recent low trauma fracture without the need for DXA. • Younger individuals postfracture may be risk-assessed on the basis of FRAX® probability including DXA and associated treatment thresholds. • Future fracture risk is markedly influenced by both site, number, severity, and recency of prior fracture; awareness of baseline vertebral fractures facilitates definition of true incident vertebral fracture events occurring during antiosteoporosis treatment. • Detection of previously clinically silent vertebral fractures, defining site of prior fracture, might alter treatment...

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“…The availability of data to inform service performance is fundamental to the process of Quality Improvement. Two indicator sets are available that benchmark services: on an organisational level, the IOF Capture the Fracture Best Practice Framework [ 58 ]; and on at the patient level, the IOF/FFN/NOF key performance indicator set [ 59 ] (Fig. 2 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and efficiency of fracture liaison services to reduce the risk of recurrent osteoporotic fractures

Javaid

2021

Aging Clin Exp Res

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Background Acting to prevent the next fracture after a sentinel fracture is support by the evidence base and brings benefits for patients, clinicians and healthcare systems. However, more patients after a fragility fracture remain untreated and vulnerable to future potentially life-changing fractures. Fracture liaison services (FLS) are models of care that can close this care gap. Methods A narrative review of the key evidence for the efficacy and effectiveness of FLS was performed Results There are few randomised control trials of FLSs and none with fracture as the primary outcome. Several observational studies have also demonstrated reductions in fracture, but most were limited by potential bias. Several studies have highlighted that not every FLS is automatically effective. Conclusion Further research should focus on implementing effective FLS using published standards and only then exploring impacts on patient outcomes such as refracture rates.

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A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network

Cited by 77 publications

References 70 publications

Implementation of a Postfracture Care Program in a Private Hospital in Colombia

Implementation of a Postfracture Care Program in a Private Hospital in Colombia

Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services

Efficacy and efficiency of fracture liaison services to reduce the risk of recurrent osteoporotic fractures

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