Post-fracture care programs for prevention of subsequent fragility fractures: a literature assessment of current trends

Åkesson, Kristina; Ganda, Kirtan; Deignan, Cynthia; Oates, Mary; Volpert, A; Brooks, K; Lee, D; Dirschl, Douglas R.; Singer, Andrea

doi:10.1007/s00198-022-06358-2

Cited by 21 publications

(12 citation statements)

References 82 publications

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“…The low rate of preventive intervention in these studies is consistent with the widely documented so-called care gap in clinical practice 32 , i.e., the gap between evidence-based guideline recommendations for provision of preventive care and the widespread lack of treatment after hip fracture 33 . The failure, over the past 20 years, of individual practitioners and health systems to correct the well-documented lack of preventive treatment for high-risk patients who have sustained a hip fracture is a perplexing problem that has resisted correction 34,35 . In recent years, intensive focus has been placed on developing and implementing systematic fracture prevention programs in numerous countries [36][37][38][39] .…”

Section: Discussionmentioning

confidence: 99%

High Rates of Imminent Subsequent Fracture After Femoral Neck Fracture in the Elderly

Bogoch

Marcano-Fernández

Schemitsch

et al. 2022

Journal of Bone and Joint Surgery

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Background:Fragility fractures of the hip are known to be followed frequently by subsequent fragility fractures, including second hip fractures. Data on subsequent fractures are available for aggregated index femoral neck and intertrochanteric femoral fractures, grouped generically as hip fractures, but not specifically for femoral neck fractures. There is increasing recognition that a subsequent fracture often occurs early after a hip fracture in the elderly, creating an emphasis on the concept of “imminent fracture risk.” Since 2000, there have been many reports on the care gap in interventions after a fragility fracture, with concern regarding the slow uptake of appropriate systemic treatments designed to prevent a subsequent fracture in high-risk patients.Methods:As planned a priori, we performed an analysis of subsequent fractures after an index femoral neck fracture in 2 prospective clinical trials involving 2,520 patients from 90 sites on 5 continents. We recorded the incidence and time of occurrence of all secondary fragility fractures as well as the reported use of bone-protective medication in all subjects.Results:In the 24 months following the index femoral neck fracture, 226 (9.0%) of 2,520 patients sustained at least 1 subsequent fragility fracture, including 113 hip fractures (4.5%). The median interval from the index fracture to a subsequent fracture was approximately 9.0 months. Only 25.2% (634) of the 2,520 patients reported using bone-protective medications at any time during follow-up. Female patients, those with nondisplaced index fractures, and those treated with arthroplasty, were more likely to have received protective medication.Conclusions:Subsequent fractures, including second hip fractures, occurred frequently and early following an index femoral neck fracture in 2 large global cohorts. Interventions to prevent a subsequent fracture were instituted in only 1 of 4 patients, even though a focused directive was included in both study protocols.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

High Rates of Imminent Subsequent Fracture After Femoral Neck Fracture in the Elderly

Bogoch

Marcano-Fernández

Schemitsch

et al. 2022

Journal of Bone and Joint Surgery

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“…The traditional ineffectiveness of the osteoporotic fragility fracture care has been attributed to the fragmentation of the service. A major project was launched by the IOF to develop a comprehensive approach to post-fracture care [2]. This was based on variable components from several classification systems as well as clinical/quality standards.…”

Section: Elements Of Highly Functioning Pfc Programmentioning

confidence: 99%

“…The primary goals of PFC are to prevent subsequent fractures and to improve overall outcomes (morbidity, mortality, and/ or physical function) [2]. Based on that, PFC services consist of five main components: case identification; osteoporosis assessment including dual energy X-ray absorptiometry (DXA) scan to measure bone mineral density and fracture risk assessment; treatment initiation with an osteoporosis therapy; systems to improve adherence and persistence with therapy, in addition to falls risk assessment and management [3].…”

Section: Introductionmentioning

confidence: 99%

Post-fracture care program in Egypt: merging subsequent fracture prevention and improving patients’ outcomes—an initiative by the Egyptian Academy of Bone Health

Miedany

El-Naby

Abu-Zaid

et al. 2023

Egypt Rheumatol Rehabil

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Background Despite the associated high prevalence of morbidity and mortality, osteoporotic fragility fractures remain underdiagnosed and undertreated. Furthermore, those who sustain a fragility fracture are at imminent risk of sustaining subsequent fractures. Post-fracture care (PFC) programs are systematic, coordinated care programs that recognize, evaluate, and manage older adults who sustained a fragility fracture with the goal of managing all the risk factors and preventing succeeding fractures. Main text This work was carried out to outline the PFC program adopted in Egypt and its applicability in standard clinical practice. A review of literature was conducted to identify an evidence-informed PFC strategies and protocols, which outlines the optimal manner to manage older adults living with fragility fractures. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to guide the reporting of this review. Based on this, a PFC integrated model of care based on a patient-centered approach has been developed aiming to optimize the outcomes. Conclusion This manuscript described the integrated model of care adopted in Egypt to provide care for older adults presenting with fragility fractures. This will pave the way to standardize patient identification and management. Additionally, to prevent occurrence of subsequent fractures and to enhance equity of care for patients with fragility fracture and osteoporosis, expansion of such service to rural and remote areas is highly recommended.

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“…Hip fracture patients also benefit from postoperative rehabilitation ( Åkesson et al, 2022 ). Early mobilization (within 24 h post-surgery) avoids prolonged bed rest and prevents complications ( Parker, 2000 ).…”

Section: Introductionmentioning

confidence: 99%

Post-fracture care programs for prevention of subsequent fragility fractures: a literature assessment of current trends

Cited by 21 publications

References 82 publications

High Rates of Imminent Subsequent Fracture After Femoral Neck Fracture in the Elderly

High Rates of Imminent Subsequent Fracture After Femoral Neck Fracture in the Elderly

Post-fracture care program in Egypt: merging subsequent fracture prevention and improving patients’ outcomes—an initiative by the Egyptian Academy of Bone Health

Risk prediction of second hip fracture by bone and muscle density of the hip varies with time after first hip fracture: A prospective cohort study

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