Fracture Risk Assessment and How to Implement a Fracture Liaison Service

Fuggle, Nicholas R; Javaid, M K; Fujita, Masaki; Halbout, Philippe; Dawson‐Hughes, Bess; Rizzoli, René; Reginster, Jean‐Yves; Kanis, John А.; Cooper, Cyrus

doi:10.1007/978-3-030-48126-1_14

Cited by 11 publications

(5 citation statements)

References 44 publications

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“…Despite this, many clinicians and healthcare systems continue to fail in identifying and managing future fracture risk in patients who have already sustained fractures [29][30][31]. The advent of fracture liaison services has been designed to provide a mechanism that ensures better capture and assessment of this at-risk population going forward [32][33][34][35][36].…”

Section: Prior Fracturementioning

confidence: 99%

Update on fracture risk assessment in osteoporosis

McCloskey,

Tan,

Schini

2024

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review The assessment of fracture risk is playing an ever-increasing role in osteoporosis clinical management and informing international guidelines for osteoporosis. FRAX, a fracture risk calculator that provides individualized 10-year probabilities of hip and major osteoporotic fracture, has been widely used since 2008. In this review, we recap the development and limitations of intervention thresholds and the role of absolute fracture risk. Recent findings There is an increasing awareness of disparities and inequities in the setting of intervention thresholds in osteoporosis. The limitations of the simple use of prior fracture or the DXA-derived BMD T-score threshold are increasingly being discussed; one solution is to use fracture risk or probabilities in the setting of such thresholds. This approach also permits more objective assessment of high and very high fracture risk to enable physicians to make choices not just about the need to treat but what agents to use in individual patients. Summary Like all clinical tools, FRAX has limitations that need to be considered, but the use of fracture risk in deciding who to treat, when to treat and what agent to use is a mechanism to target treatment equitably to those at an increased risk of fracture.

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Section: Prior Fracturementioning

confidence: 99%

Update on fracture risk assessment in osteoporosis

McCloskey,

Tan,

Schini

2024

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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“…Nonetheless, the proposal has arisen because of the failure of many clinicians and healthcare systems to identify and manage future fracture risk in patients who have already sustained fractures in whom undetected osteoporosis has also remained un-investigated and untreated [1,29,30]. This failure can be addressed, and is being addressed, without the need to alter the definition of osteoporosis [31][32][33][34][35][36][37][38].…”

Section: The Use Of Prior Fracture As a Diagnostic Thresholdmentioning

confidence: 99%

The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis

et al. 2022

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This position paper of the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) addresses the rationale for separate diagnostic and intervention thresholds in osteoporosis. We conclude that the current BMD-based diagnostic criteria for osteoporosis be retained whilst clarity is brought to bear on the distinction between diagnostic and intervention thresholds.

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“…It is beneficial and cost-effective. By managing falls and osteoporosis, these services are invaluable for reducing repeated fractures [48,49]. A hip fracture audit is relatively established in some regions in the world, but an audit of other fragility fractures is less common.…”

Section: ) Postoperative Carementioning

confidence: 99%

Orthogeriatrics: a vital requirement for improving fragility fracture patient care internationally with particular reference to Turkey

et al. 2021

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Purpose Orthogeriatrics is a team approach that aims to provide adequate and timely intervention for individuals suffering from fragility fractures, particularly hip fractures. These patients are mostly the frailest older adults. The aim of orthogeriatrics is to re-gain functionality as early as possible and to decrease disability and mortality. Some developed countries have established orthogeriatric services, while many others, including Turkey, have so far not. Here, to identify areas for improvement, we outline the status of the orthogeriatrics in older adults in Turkey. Methods We present clear calls for action, emphasizing possible and noteworthy areas for improvement. Results Our proposals include the need for an easily applied, short version of comprehensive geriatric assessment; appropriate laboratory testing on admission; paracetamol with a special emphasis in its dosings and clues for state-of-the-art analgesic management; the essential need to introduce oral nutritional supplementation, irrespective of nutritional status; the need for vitamin D commencement, in almost all patients; and starting osteoporosis treatment in fracture hospitalization, whenever appropriate. Last but not least, the ever-increasing prerequisite to establish "fracture liaison services" is stipulated. Conclusion We suggest that our recommendations offer great potential in Turkey, for the improvement of frail fracture patients' care. We call the other countries that do not have established orthogeriatric lines to model our approach to improve the management of fracture patients globally. Keywords Orthogeriatrics • Improve • Care • Fragility fracture • Turkey Abbreviations ACS Acute coronary syndromes BCIS Bone cement implantation syndrome CGA Comprehensive geriatric assessment CKD Chronic kidney disease COPD Chronic obstructive pulmonary disease CRP C-reactive protein ECG Electrocardiogram FFFAP Falls and Fragility Fracture Audit Programme FIC Fascia iliaca compartment FLS Fracture Liaison Service

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Fracture Risk Assessment and How to Implement a Fracture Liaison Service

Cited by 11 publications

References 44 publications

Update on fracture risk assessment in osteoporosis

Update on fracture risk assessment in osteoporosis

The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis

Orthogeriatrics: a vital requirement for improving fragility fracture patient care internationally with particular reference to Turkey

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