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

Abstract

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.

Characterization and effectiveness of a Fracture Liaison Services program in Colombia

“…Hip fractures were the most frequent fracture, which is consistent with other studies conducted in Colombia (36.7%-58.2%) [ 10 , 11 , 26 ], Spain (33.6% -45.0%) [ 23 , 24 ] and the United States (35.3%) [ 28 ]. It is important to highlight that vertebral fractures were found in almost a quarter of the patients, similar to the findings of other reports (22.6%-28.1%) [ 10 , 22 , 23 ] but in contrast with other research (39.0%-64.2%) [ 13 – 15 , 18 , 19 ]. It has been reported in the literature that the anatomical location of fractures may differ between women and men.…”

“…The median age of the patients was similar to that found in other studies (75.3–79.0 years) [ 10 – 17 ], with a predominance of women, as identified by previous studies (71.0–91.1%) [ 10 – 15 , 17 – 26 ]. Similarly, the Charlson Comorbidities Index of these patients was high, as described in the literature [ 12 , 15 , 19 ].…”

“…Similarly, the Charlson Comorbidities Index of these patients was high, as described in the literature [ 12 , 15 , 19 ]. A total of 29.7% had a history of fractures, which is consistent with what was found in a Colombian study (27.3%) [ 10 ] and contrasts with what was found in European countries (45.9%-53.0%) [ 15 , 19 – 21 ] and South America (39.1%-40.0%) [ 11 , 22 ]. These conditions have been considered risk factors for the appearance of new fragility fractures.…”

“…[ 2 ]. However, only 16.7% of the patients were receiving an antiosteoporotic drug, showing poor coverage as previously described in the country (7.0%-12.1%) [ 10 , 11 , 17 , 27 ] and in the world (10.8%-21.3%) [ 15 , 18 – 22 , 24 ].…”

“…This latter plan provides coverage for the surgical and medical management of fractures, as well as specific medications approved for the management of osteoporosis. Although the evidence shows that Fracture Liaison Services programs reduce mortality and the risk of refractures and increase treatment and adherence rates [ 1 , 5 , 8 ], there are few studies published on postfracture care programs in the country, and there is no information on their effectiveness [ 10 , 11 ]. Consequently, the present study aims to determine the characteristics of patients over 50 years old who suffered fractures and the effectiveness of a Fracture Liaison Services program in a health care institution in Colombia.…”