Implementation of a Mandatory Rheumatology Osteoporosis Consultation in Patients With Low-Impact Hip Fracture

Quintos-Macasa, Anne-Marie; Quinet, Robert; Spady, M; Zakem, Jerald; Davis, William J.; Menon, Yamini; Serebro, Leonard; Krousel‐Wood, Marie

doi:10.1097/01.rhu.0000260497.84746.dd

Cited by 14 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, in Hawker et al [2] and Laslett et al [11], combinations of OP medications and supplements were reported such that we could not discriminate between medication and supplements. Similarly, Quintos-Macasa [32] reported "treatment" as calcium, vitamin D, or OP medication and Gardner et al [6] reported "treatment" as including calcium and OP medication together.…”

Section: Discussionmentioning

confidence: 99%

Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients

et al. 2011

View full text Add to dashboard Cite

This study aims to determine osteoporosis (OP) investigation and treatment within post-fracture initiatives conducted in fracture clinics and other orthopedic environments. A systematic review was conducted. Eligibility criteria were: hip fracture patients plus all other fracture patients presenting with a fragility fracture, orthopedic setting where orthopedic physicians/staff were involved, intervention to improve OP management, primary data on ≥20 patients from randomized controlled trials (RCTs) and other study designs. We calculated outcome data within 6 months of screening from an intention-to-treat principle to derive an equated proportion (EP) across interventions. Outcomes were: (1) proportion of patients investigated with bone densitometry, (2) proportion of patients initiating OP medication, and (3) proportion of patients taking OP medication. We identified 2,259 citations, of which 57 articles that included 64 intervention groups were eligible. The median EP for patients investigated was 43% and the 75th percentile was 71%. The median EP for medication initiation was 22% and the 75th percentile was 34%. The median EP for medication taking was 27.5% and the 75th percentile was 43%. The EPs for all outcomes were higher for interventions with dedicated personnel to implement the intervention and those within which bone mineral density testing and/or treatment were included. In studies with an EP, up to 71% of patients were investigated for OP, but <35% initiated medication, and <45% were taking medication within 6 months of screening. Calculating an EP allowed us to compare outcomes across the studies, therefore capturing both RCTs and other study designs typical of real-world settings.

show abstract

Section: Discussionmentioning

confidence: 99%

Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients

et al. 2011

View full text Add to dashboard Cite

show abstract

“…6 Although a number of postfracture interventions have been attempted (Table 5), the most successful were those performed in the hospital. [7][8][9][10] The most comprehensive of these was the Kaiser Southern California program, which included a standardized admission order sheet with screening for secondary causes of osteoporosis and discharge orders with referral for fall prevention, a primary care or specialty consult for evaluation of secondary causes of osteoporosis, and options for the surgeon to order a DXA scan and antiosteoporosis medications. 11 Successful improvements in therapy were also achieved in the outpatient setting when patients were recruited by medical records review during hospitalization or after discharge 12 or identified through orthopaedic billing records 13 and requested to be enrolled in an osteoporosis management program.…”

Section: Discussionmentioning

confidence: 99%

An Effective Team Approach to Improve Postoperative Hip Fracture Care

Piziak

Rajab

2011

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

show abstract

“…Most of these studies were educational interventions directed to the primary care provider either directly from the orthopaedic surgeon [35][36][37][38][39] or indirectly via the patient [25,[40][41][42][43]. One intervention focused on providing patient-specific education including BMD results directly to the primary care physician [22].…”

Section: Review Of Case-finding Systems In Fracture Unitsmentioning

confidence: 99%

Coordinator-based systems for secondary prevention in fragility fracture patients

et al. 2011

View full text Add to dashboard Cite

The underlying causes of incident fractures--bone fragility and the tendency to fall--remain under-diagnosed and under-treated. This care gap in secondary prevention must be addressed to minimise both the debilitating consequences of subsequent fractures for patients and the associated economic burden to healthcare systems. Clinical systems aimed at ensuring appropriate management of patients following fracture have been developed around the world. A systematic review of the literature showed that 65% of systems reported include a dedicated coordinator who acts as the link between the orthopaedic team, the osteoporosis and falls services, the patient and the primary care physician. Coordinator-based systems facilitate bone mineral density testing, osteoporosis education and care in patients following a fragility fracture and have been shown to be cost-saving. Other success factors included a fracture registry and a database to monitor the care provided to the fracture patient. Implementation of such a system requires an audit of existing arrangements, creation of a network of healthcare professionals with clearly defined roles and the identification of a 'medical champion' to lead the project. A business case is needed to acquire the necessary funding. Incremental, achievable targets should be identified. Clinical pathways should be supported by evidence-based recommendations from national or regional guidelines. Endorsement of the proposed model within national healthcare policies and advocacy programmes can achieve alignment of the objectives of policy makers, professionals and patients. Successful transformation of care relies upon consensus amongst all participants in the multi-disciplinary team that cares for fragility fracture patients.

show abstract

Implementation of a Mandatory Rheumatology Osteoporosis Consultation in Patients With Low-Impact Hip Fracture

Cited by 14 publications

References 19 publications

Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients

Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients

An Effective Team Approach to Improve Postoperative Hip Fracture Care

Coordinator-based systems for secondary prevention in fragility fracture patients

Contact Info

Product

Resources

About