Fracture liaison services in Ireland—how do we compare to international standards?

Dockery, Frances; Glynn, Aaron; Franks, Kendal; Carey, John J.; O’Gradaigh, Donncha; Kenny, Paddy; Askin, David; Butler, Emma E.; Sweeney, Bob; Conlon, Breda; McGregor, Bradley A.; Lannon, Rosaleen; Rooney, Bridie; Pillai, Ijaz; Fitzgerald, Ciaran

doi:10.1007/s00198-021-06251-4

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…Prior studies show fractures, particularly vertebral fractures, are underreported in Ireland. ( 27 , 28 , 29 , 32 ) We have not performed analyses of those with and without these validated fractures, which could affect our results. Risk factors and fractures are categorized simply as binary variables, rather than weighted based on a dose, duration, or severity.…”

Section: Discussionmentioning

confidence: 99%

“…( 4 ) The cost of managing those who fracture will double by 2030. ( 25 ) Despite some progress in understanding fracture admissions to public hospitals among older persons, ( 26 , 27 , 28 ) national validated data do not exist related to the prevalence of osteoporosis or incidence of major osteoporotic fracture. ( 27 , 28 , 29 , 30 , 31 ) This may be contributing to why osteoporosis is not a national healthcare priority.…”

Section: Introductionmentioning

confidence: 99%

“…( 25 ) Despite some progress in understanding fracture admissions to public hospitals among older persons, ( 26 , 27 , 28 ) national validated data do not exist related to the prevalence of osteoporosis or incidence of major osteoporotic fracture. ( 27 , 28 , 29 , 30 , 31 ) This may be contributing to why osteoporosis is not a national healthcare priority. ( 4 ) We established a large convenience cohort of >36,000 patients across multiple sites to examine the epidemiology of osteoporosis in Ireland, and to assess the validity of DXA biometrics, algorithms, and classification criteria for Irish adults.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Low Bone Mass and Osteoporosis in Ireland: the Dual‐Energy X‐Ray Absorptiometry (DXA) Health Informatics Prediction (HIP) Project

Carey

Erjiang²,

Wang

et al. 2023

JBMR Plus

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Osteoporosis is a common disease that has a significant impact on patients, healthcare systems, and society. World Health Organization (WHO) diagnostic criteria for postmenopausal women were established in 1994 to diagnose low bone mass (osteopenia) and osteoporosis using dual‐energy X‐ray absorptiometry (DXA)‐measured bone mineral density (BMD) to help understand the epidemiology of osteoporosis, and identify those at risk for fracture. These criteria may also apply to men ≥50 years, perimenopausal women, and people of different ethnicity. The DXA Health Informatics Prediction (HIP) project is an established convenience cohort of more than 36,000 patients who had a DXA scan to explore the epidemiology of osteoporosis and its management in the Republic of Ireland where the prevalence of osteoporosis remains unknown. In this article we compare the prevalence of a DXA classification low bone mass (T‐score < −1.0) and of osteoporosis (T‐score ≤ −2.5) among adults aged ≥40 years without major risk factors or fractures, with one or more major risk factors, and with one or more major osteoporotic fractures. A total of 33,344 subjects met our study inclusion criteria, including 28,933 (86.8%) women; 9362 had no fractures or major risk factors, 14,932 had one or more major clinical risk factors, and 9050 had one or more major osteoporotic fractures. The prevalence of low bone mass and osteoporosis increased significantly with age overall. The prevalence of low bone mass and osteoporosis was significantly greater among men and women with major osteoporotic fractures than healthy controls or those with clinical risk factors. Applying our results to the national population census figure of 5,123,536 in 2022 we estimate between 1,039,348 and 1,240,807 men and women aged ≥50 years have low bone mass, whereas between 308,474 and 498,104 have osteoporosis. These data are important for the diagnosis of osteoporosis in clinical practice, and national policy to reduce the illness burden of osteoporosis. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of Low Bone Mass and Osteoporosis in Ireland: the Dual‐Energy X‐Ray Absorptiometry (DXA) Health Informatics Prediction (HIP) Project

Carey

Erjiang²,

Wang

et al. 2023

JBMR Plus

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“…Therefore, capturing the patient very early after their fracture is essential. 20 Knowing that half of all hip fracture patients have had a warning fracture, we should then be able to predict who is at risk of a hip fracture and take steps to prevent such occurrences. History of fracture at other sites also increases the risks of future fractures, for example, one study showed that after sustain ing a distal forearm fracture, the incidence of a subsequent fracture was 55% by 10 years and 80% by 20 years.…”

Section: Risk Assessment For Osteoporosismentioning

confidence: 99%

An overview of the management of osteoporosis in the aging female population

Amin

McPartland

O’Sullivan

et al. 2023

Womens Health (Lond Engl)

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Osteoporosis is a systemic skeletal disease that is a cause of morbidity and mortality. It can affect all ages but most frequently postmenopausal women. It is a silent condition, however, osteoporotic fractures can lead to significant pain and disability. In this review article, we aim to review the clinical approach to the management of postmenopausal osteoporosis. We include risk assessment, investigations, and the various pharmacological and non-pharmacological options used in the treatment of osteoporosis. We have discussed the pharmacological options individually including their mechanism of action, safety profile, effects on bone mineral density and fracture risks, and duration of use. Potential new treatments are also discussed. The importance of sequence in the use of osteoporotic medicine is also highlighted in the article. An understanding of the different treatment options will hopefully help in the management of this very common and debilitating condition.

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“…National publications suggest that available data reflect the ‘tip of the iceberg,’ and the financial costs of managing people with these fractures will double during this decade, rising to €2billion by 2030 [ 5 – 7 ]. Recent programs established national standards for the management and audit of hip fracture care among adults aged ≥ 60 years of age and fracture liaison services [ 8 , 9 ]. These reflect the current state of fragility fracture care, variation in osteoporosis diagnosis, risk assessment and management, some progress, while also highlighting substantial needs including increases in resources, data, policy, priority, and logistics [ 3 , 5 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX

Yang

Dempsey²,

Brennan³

et al. 2023

Arch Osteoporos

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Summary Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. Purpose FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. Method A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland–Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. Results Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. Conclusions Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.

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Fracture liaison services in Ireland—how do we compare to international standards?

Cited by 5 publications

References 20 publications

Prevalence of Low Bone Mass and Osteoporosis in Ireland: the Dual‐Energy X‐Ray Absorptiometry (DXA) Health Informatics Prediction (HIP) Project

Prevalence of Low Bone Mass and Osteoporosis in Ireland: the Dual‐Energy X‐Ray Absorptiometry (DXA) Health Informatics Prediction (HIP) Project

An overview of the management of osteoporosis in the aging female population

Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX

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