Fracture liaison service model: treatment persistence 5 years later

Naranjo, Antonio; Molina, Antonio González; Quevedo, Adrián; Rubiño, Francisco; Sánchez‐Alonso, Fernando; Rodríguez‐Lozano, Carlos; Ojeda, Soledad

doi:10.1007/s11657-021-00925-6

Cited by 14 publications

(15 citation statements)

References 18 publications

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“…Most patients who start treatment will remain in treatment up to 5 years, according to retrospective administrative data collected on 888 patients. 24 In our study, the probability of adherence to 3 months of treatment with bisphosphonates or denosumab was 93.5% and 97.3% in groups A and B, respectively, which was not significantly different (p = 0.273); the 1-year adherence rates were 51.9% and 73.5%, and the 3-year adherence rates were 26% and 57.5%, respectively. Thus, in comparison with those who did not receive OWFLS, adherence was better in patients included in OWFLS (p = 0.003, p < 0.0001, respectively).…”

Section: Discussioncontrasting

confidence: 46%

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

Cai,

Ying,

Zhang

et al. 2024

J Int Med Res

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Objective We established an orthopedic ward fracture liaison services (OWFLS) model and evaluated its role in improving detection rates of bone metabolic markers, treatment rates, and long-term treatability. Methods This observational retrospective cohort study included 120 patients aged >50 years hospitalized for primary osteoporotic fracture from January 2018 to January 2019 (group A: not included in OWFLS). Group B (included in OWFLS) comprised 120 patients from February 2019 to February 2020. We compared rates of bone metabolic index testing, treatment, and adherence; symptomatic improvement; and recurrent fracture between groups. Results Rates of bone metabolism index testing (50% vs. 0%) and medication use (94.2% vs. 64.2%) were significantly higher after OWFLS implementation. There was no significant difference in adherence rates at 3 months between groups (97.3% vs. 93.5%). Adherence rates at 1 and 3 years were better in group B than A (73.5% vs. 51.9%; 57.5% vs. 26%, respectively). Recurrence of bone pain at 1 and 3 years was significantly lower in group B than A (20.4% vs. 46.8%; 45.1% vs. 76.6%, respectively). Conclusions OWFLS improved the detection rate of bone metabolism indicators, treatment rate, and patient adherence and reduced recurrence of bone pain. OWFLS may be suitable for settings lacking human resources.

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Section: Discussioncontrasting

confidence: 46%

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

Cai,

Ying,

Zhang

et al. 2024

J Int Med Res

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“…These sensitivity analyses showed that the introduction of more conservative FLS also would provide favorable efficiency results from the SNS perspective. As recent data on the evolution of persistence in FLS become available at Spanish level, 50 a sensitivity scenario analysis was conducted supporting the results of the base case. Although the results of this scenario should be treated with caution due to differences in patient characteristics between studies, it also suggested that implementing an FLS program would provide clinical benefits to patients (0.003 LY and 0.035 QALY per patient) with limited incremental costs of € 356,32 per patient, resulting in an ICUR below the commonly accepted willingness-to-pay thresholds.…”

Section: Discussionmentioning

confidence: 92%

Cost-Effectiveness Analysis of Fracture Liaison Services Compared with Standard of Care in the Secondary Prevention of Fragility Fractures in Spain

Naranjo¹,

Prieto-Alhambra²,

Sánchez-Martín³

et al. 2022

CEOR

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Purpose To assess the cost-effectiveness of a Fracture Liaison Service (FLS) compared with standard care for the secondary prevention of fragility fractures in Spain. Methods Patients with osteoporosis and an initial fragility fracture who were candidates to initiate osteoporosis treatment (mean age 65 years, 90.7% female) were included in the model. Disease progression was simulated with a Markov model through seven health states (with and without osteoporosis treatment, subsequent hip, vertebral, forearm and humerus fracture, and death). A time horizon of 10 years and a 6-month duration per cycle was set. Clinical, economic, and quality of life parameters were estimated from the literature and Spanish clinical practice. Resource use and treatment patterns were validated by an expert panel. The Spanish National Health System (SNS) perspective was adopted, taking direct costs (€; 2020) into account. Effectiveness was measured in life-years gained (LYG) and quality-adjusted life years gained (QALYs). A discount rate of 3% was applied to costs and outcomes. The uncertainty of the parameters was assessed using deterministic, scenario and probabilistic sensitivity analyses (1000 iterations). Results Setting up a FLS for the secondary prevention of fragility fractures in Spain would provide better osteoporosis treatment initiation and persistence. This would reduce subsequent fragility fractures, disutilities and deaths. FLS would have greater clinical benefits (0.008 and 0.082 LYG and QALY gained per patient, respectively) and higher costs (€563.69 per patient) compared with standard care, leading to an incremental cost-utility ratio of €6855.23 per QALY gained over the 10 years horizon. The sensitivity analyses showed limited dispersion of the base case results, corroborating their robustness. Conclusion From the SNS perspective and considering Spanish willingness-to-pay thresholds, the introduction of FLS for the secondary prevention of fragility fractures would be a cost-effective strategy.

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“…15,28 Another cross-sectional study found that one-third of NH residents with the diagnosis of osteoporosis receive treatment. 29 FLS have been shown to achieve high rates of osteoporosis treatment and adherence in community-dwellers, 30,31 Additional investigation is needed to determine whether this model improves the quality of shared decision-making and osteoporosis treatment rates in the NH setting.…”

Section: Discussionmentioning

confidence: 99%

Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents

Berry,

Hecker,

McConnell

et al. 2023

J American Geriatrics Society

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BackgroundMedication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study.MethodsThis was a non‐randomized trial (pilot study) including NH staff and residents from five facilities. Long‐stay residents at high‐risk for injurious falls were identified using a validated risk calculator and staff referral. A remote team reviewed the electronic health record (EHR) and provided recommendations as Injury Prevention Plans (IPP). A research nurse served as a care coordinator focused on resident engagement and shared decision‐making. Outcomes included implementation measures, as identified in the EHR, and surveys and interviews with staff.ResultsAcross five facilities, 274 residents were screened for eligibility, and 46 residents (16.8%) were enrolled. Most residents were female (73.9%) and had dementia (63.0%). An IPP was completed for 45 residents (97.8%). The nurse made a total of 93 deprescribing recommendations in 36 residents (80% of residents had one or more deprescribing recommendation; mean 2.2 recommendations/resident). Twenty of 45 residents (44.4%) had a recommendation for osteoporosis treatment. Among residents with recommendations, 21/36 (58.3%) had one or more deprescribing orders written and 6/20 (30.0%) had an osteoporosis medication prescribed. At 4 months, most medication changes persisted. Adverse side effects were rare. Staff members identified several areas for program refinement, including aligning recommendations with provider workflow and engaging consultant psychiatrists.ConclusionsA remote injury prevention service is safe and feasible to enhance deprescribing and osteoporosis treatment in long‐stay NH residents at risk for injury. Additional investigation is needed to determine if this model could reduce injurious falls when deployed across NH chains.

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Fracture liaison service model: treatment persistence 5 years later

Cited by 14 publications

References 18 publications

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

Cost-Effectiveness Analysis of Fracture Liaison Services Compared with Standard of Care in the Secondary Prevention of Fragility Fractures in Spain

Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents

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