Osteoporosis fracture liaison experience: the Belfast experience

Wright, Stephen; McNally, Colette; Beringer, T. R. O.; Marsh, David; Finch, M B

doi:10.1007/s00296-004-0573-7

Cited by 11 publications

(4 citation statements)

References 5 publications

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“…The collaborative care model has been advocated by a joint international task force looking at secondary fracture prevention . One such collaborative care model is the fracture liaison service, which has become widespread in the United Kingdom and some U.S. healthcare systems . For collaborative care models to improve the care of patients with fragility fractures likely requires the engagement and leadership of the orthopedic community .…”

Section: Discussionmentioning

confidence: 99%

“…(30) One such collaborative care model is the fracture liaison service, which has become widespread in the United Kingdom and some U.S. healthcare systems. (31)(32)(33) For collaborative care models to improve the care of patients with fragility fractures likely requires the engagement and leadership of the orthopedic community. (34) Outpatient follow-up of patients with recent hip fracture has many challenges, including transportation, comorbid medical problems, and often the requirement of a family member to accompany the patient.…”

Section: Discussionmentioning

confidence: 99%

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Osteoporosis Medication Use After Hip Fracture in U.S. Patients Between 2002 and 2011

Solomon

Johnston

Boytsov

et al. 2014

Journal of Bone and Mineral Research

315

197

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Hip fractures are common, morbid, costly, and associated with subsequent fractures. Historically, postfracture osteoporosis medication use rates have been poor, but have not been recently examined in a large-scale study. We conducted a retrospective, observational cohort study based on U.S. administrative insurance claims data for beneficiaries with commercial or Medicare supplemental health insurance. Eligible participants were hospitalized for hip fracture between January 1, 2002, and December 31, 2011, and aged 50 years or older at admission. The outcome of interest was osteoporosis medication use within 12 months after discharge. Patients were censored after 12 months, loss to follow-up, or a medical claim for cancer or Paget's disease, whichever event occurred first. During the study period, 96,887 beneficiaries met the inclusion criteria; they had a mean age of 80 years and 70% were female. A total of 34,389 (35.5%) patients were censored before reaching 12 months of follow-up. The Kaplan-Meier estimated probability of osteoporosis medication use within 12 months after discharge was 28.5%. The rates declined significantly from 40.2% in 2002, to 20.5% in 2011 (p for trend <0.001). In multivariable Cox proportional hazards models, a number of patient characteristics were associated with reduced likelihood of osteoporosis medication use, including older age and male gender. However, the predictor most strongly and most positively associated with osteoporosis medication use after fracture was osteoporosis medication use before the fracture (hazard ratio = 7.45; 95% confidence interval [CI], 7.23–7.69). Most patients suffering a hip fracture do not use osteoporosis medication in the subsequent year and treatment rates have worsened. © 2014 Eli Lilly and Company. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Osteoporosis Medication Use After Hip Fracture in U.S. Patients Between 2002 and 2011

Solomon

Johnston

Boytsov

et al. 2014

Journal of Bone and Mineral Research

315

197

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“…Many previous interventions, however, have focused on bone health management, and to our knowledge only a few studies [18,20] have included patient referral for falls risk assessment. Osteoporosis care can be improved, but as fractures occur because of low bone mass and falls , it is important to also address falls risk [24].…”

Section: Introductionmentioning

confidence: 99%

Post-discharge management following hip fracture - get you back to B4: A parallel group, randomized controlled trial study protocol

et al. 2011

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BackgroundFall-related hip fractures result in significant personal and societal consequences; importantly, up to half of older adults with hip fracture never regain their previous level of mobility. Strategies of follow-up care for older adults after fracture have improved investigation for osteoporosis; but managing bone health alone is not enough. Prevention of fractures requires management of both bone health and falls risk factors (including the contributing role of cognition, balance and continence) to improve outcomes.Methods/DesignThis is a parallel group, pragmatic randomized controlled trial to test the effectiveness of a post-fracture clinic compared with usual care on mobility for older adults following their hospitalization for hip fracture. Participants randomized to the intervention will attend a fracture follow-up clinic where a geriatrician and physiotherapist will assess and manage their mobility and other health issues. Depending on needs identified at the clinical assessment, participants may receive individualized and group-based outpatient physiotherapy, and a home exercise program. Our primary objective is to assess the effectiveness of a novel post-discharge fracture management strategy on the mobility of older adults after hip fracture.We will enrol 130 older adults (65 years+) who have sustained a hip fracture in the previous three months, and were admitted to hospital from home and are expected to be discharged home. We will exclude older adults who prior to the fracture were: unable to walk 10 meters; diagnosed with dementia and/or significant comorbidities that would preclude their participation in the clinical service.Eligible participants will be randomly assigned to the Intervention or Usual Care groups by remote allocation. Treatment allocation will be concealed; investigators, measurement team and primary data analysts will be blinded to group allocation. Our primary outcome is mobility, operationalized as the Short Physical Performance Battery at 12 months. Secondary outcomes include frailty, rehospitalizations, falls risk factors, quality of life, as well as physical activity and sedentary behaviour. We will conduct an economic evaluation to determine health related costs in the first year, and a process evaluation to ascertain the acceptance of the program by older adults, as well as clinicians and staff within the clinic.Trial registration numberClinicalTrials.gov: NCT01254942

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“…The Fracture Liaison Service model has been adopted by a growing number of UK hospitals since publication of the previous BOA Blue Book on care of the fragility fracture patient in September 2003. [47][48][49][50] However, a national audit published in 2006 40 suggested that only 27% of hospitals in England had established an FLS and so identified a major opportunity to improve integrated care of the fragility fracture patient across the UK in the future.…”

Section: Standardmentioning

confidence: 99%

The orthogeriatric cycle and orthogeriatric taxonomy: definitions, classifications, and conceptual elements for a better clinical practice

Dinamarca‐Montecinos

2023

Geriatr Gerontol Aging

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The incidence of fragility fractures is increasing. This group of diseases, mainly hip fractures, has enormous clinical, social, organizational, epidemiological, and economic impact. Orthogeriatrics emerged in the 1960s as a response to the impact of hip fractures on health systems. Since then, the cost-effectiveness of co-management models has been demonstrated, and the field of orthogeriatrics has expanded from acute care to prevention, rehabilitation, and follow-up, including involvement from clinical, academic, administrative, and political sectors. This has made associated indicators and standards increasingly complex. Moreover, orthogeriatrics initiatives are quite diverse throughout the world, since they arise due to varied local circumstances. Thus, it is necessary to review the foundations of the specialty to facilitate decision-making, comparison between models, and continuous improvement. In this article, we review current definitions and concepts in orthogeriatrics based on classic publications. We also reviewed the classifications of care models and carried out an evolutionary analysis of the field. Finally, we propose a taxonomic system that considers clinical, evolutionary, and functional aspects.

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Osteoporosis fracture liaison experience: the Belfast experience

Cited by 11 publications

References 5 publications

Osteoporosis Medication Use After Hip Fracture in U.S. Patients Between 2002 and 2011

Osteoporosis Medication Use After Hip Fracture in U.S. Patients Between 2002 and 2011

Post-discharge management following hip fracture - get you back to B4: A parallel group, randomized controlled trial study protocol

The orthogeriatric cycle and orthogeriatric taxonomy: definitions, classifications, and conceptual elements for a better clinical practice

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