The Fracture Liaison Service of the Virgen Macarena University Hospital Reduces the Gap in the Management of Osteoporosis, Particularly in Men. It Meets the International Osteoporosis Foundation Quality Standards

Olmo-Montes, Francisco Jesús; Hernández‐Cruz, Blanca; Miranda, Ma José; Jimenez-Moreno, Ma Dolores; Vázquez-Gámez, MA; Giner, Mercè; Colmenero, M.; Pérez-Venegas, J.J.; Montoya-García, María-José

doi:10.3390/jcm10184220

Cited by 7 publications

(7 citation statements)

References 38 publications

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“…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.…”

Section: Discussionsupporting

confidence: 90%

“…The most prescribed antiosteoporotic drug at the time of discharge and in outpatient check-ups was teriparatide, which is consistent with what was reported in a local study (26.4%) [ 11 ] and in the United States (56.5%) [ 28 ]. Less use has been evidenced in European countries (1.0%-16.0%) [ 19 , 20 , 23 , 25 ] and Asia (1.3%-9.0%) [ 12 , 16 ]. Bisphosphonates predominate in countries such as Spain (62.6%-81.8%) [ 23 – 25 ], France (62.9%-65.5%) [ 15 , 19 ] and Thailand (26.7%) [ 12 ], while denosumab has been the most commonly used medication in Israel (57.0%) [ 16 ], Brazil (54.1%) [ 22 ] and Finland (47.5%) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Characterization and effectiveness of a Fracture Liaison Services program in Colombia

Valladales-Restrepo,

Castro-Osorio,

Ramírez-Osorio

et al. 2023

Arch Osteoporos

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Purpose Fracture Liaison Services programs reduce mortality and the risk of refracture and increase treatment and adherence rates. Greater coverage is an important priority for the future. The aim was 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. Methods This was a retrospective follow-up study of a cohort of patients with vertebral and nonvertebral fractures managed in a Fracture Liaison Services program. Sociodemographic, clinical and pharmacological variables were identified. Key performance indicators were used to evaluate the effectiveness of the program. Descriptive and bivariate analysis was performed. Results A total of 438 patients were analyzed. The average age was 77.5 years, and 78.5% were women. Hip and vertebral fractures were the most common (25.3% and 24.9%, respectively). Vertebral fractures prevailed in men (33.0% vs 22.7%; p = 0.041) and those of the radius/ulna in women (20.3% vs 10.6%; p = 0.031). A total of 29.7% had experienced a previous fracture, and 16.7% had received antiosteoporosis drugs. A total of 63.5% of the cases were managed surgically. At discharge, 58.8% received prescriptions for calcium/vitamin D, and 50.7% with prescriptions of antiosteoporotic therapy, especially teriparatide (21.2%) and denosumab (16.4%), without significant differences by sex. However, in women with hip fractures, anti-osteoporotic management prevailed (83.7% vs 64.0; p = 0.032). The effectiveness of the overall program per year was 74.6%. On follow-up, only 9.1% of patients had experienced a new fall, and of those 3.7% presented a new fracture. A total of 4.3% died during follow-up. Conclusions Good adherence to the recommendations of the country's clinical practice guidelines was found, and overall, the effectiveness of the program was very satisfactory, with a low incidence of new fractures during follow-up. Summary Fracture Liaison Services programs reduce mortality and the risk of refracture. A retrospective follow-up study of a cohort of patients with vertebral and nonvertebral fractures managed in a Fracture Liaison Services, showed that the effectiveness was 73.6%. On follow-up, 9.1% of patients had experienced a new fall, and of those 3.7% presented a new fracture.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Characterization and effectiveness of a Fracture Liaison Services program in Colombia

Valladales-Restrepo,

Castro-Osorio,

Ramírez-Osorio

et al. 2023

Arch Osteoporos

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“…Although the results of this scenario should be treated with caution due to differences in patient characteristics between studies, it also suggested that implementing an FLS program would provide clinical benefits to patients (0.003 LY and 0.035 QALY per patient) with limited incremental costs of € 356,32 per patient, resulting in an ICUR below the commonly accepted willingness-to-pay thresholds. 29 , 41 , 42 A recent publication from an FLS of Virgen Macarena University Hospital showed adherence of 96% in the first year of the program, 51 data aligned with the estimated persistence in the base case of this study.…”

Section: Discussionsupporting

confidence: 76%

Cost-Effectiveness Analysis of Fracture Liaison Services Compared with Standard of Care in the Secondary Prevention of Fragility Fractures in Spain

Naranjo¹,

Prieto-Alhambra²,

Sánchez-Martín³

et al. 2022

CEOR

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Purpose To assess the cost-effectiveness of a Fracture Liaison Service (FLS) compared with standard care for the secondary prevention of fragility fractures in Spain. Methods Patients with osteoporosis and an initial fragility fracture who were candidates to initiate osteoporosis treatment (mean age 65 years, 90.7% female) were included in the model. Disease progression was simulated with a Markov model through seven health states (with and without osteoporosis treatment, subsequent hip, vertebral, forearm and humerus fracture, and death). A time horizon of 10 years and a 6-month duration per cycle was set. Clinical, economic, and quality of life parameters were estimated from the literature and Spanish clinical practice. Resource use and treatment patterns were validated by an expert panel. The Spanish National Health System (SNS) perspective was adopted, taking direct costs (€; 2020) into account. Effectiveness was measured in life-years gained (LYG) and quality-adjusted life years gained (QALYs). A discount rate of 3% was applied to costs and outcomes. The uncertainty of the parameters was assessed using deterministic, scenario and probabilistic sensitivity analyses (1000 iterations). Results Setting up a FLS for the secondary prevention of fragility fractures in Spain would provide better osteoporosis treatment initiation and persistence. This would reduce subsequent fragility fractures, disutilities and deaths. FLS would have greater clinical benefits (0.008 and 0.082 LYG and QALY gained per patient, respectively) and higher costs (€563.69 per patient) compared with standard care, leading to an incremental cost-utility ratio of €6855.23 per QALY gained over the 10 years horizon. The sensitivity analyses showed limited dispersion of the base case results, corroborating their robustness. Conclusion From the SNS perspective and considering Spanish willingness-to-pay thresholds, the introduction of FLS for the secondary prevention of fragility fractures would be a cost-effective strategy.

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“…In the same way, a Spanish FLS reported adherence of 35% to oral bisphosphonates at 12 months in patients with hip fracture 17 . On the other hand, the FLS from Seville reported treatment adherence in the first year after of 96% in both sexes 18 .…”

Section: Discussionmentioning

confidence: 98%

Long-term persistence of treatment after hip fracture in a fracture liaison service

Naranjo

Molina

Quevedo

et al. 2022

Sci Rep

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Long-term adherence to antiosteoporosis medication (AOM) in the setting of a fracture liaison service (FLS) are not well known. Patients ≥ 50 with hip fracture seen in an FLS and recommended for treatment to prevent new fractures were analyzed. Baseline data included demographics, identification mode, previous treatment and FRAX items. Patient records were reviewed 3–8 years later, and these data were collected: (1) survival; (2) major refracture; (3) initiation of treatment, proportion of days covered (PDC) and persistence with AOM. 372 patients (mean age, 79 years; 76% women) were included. Mean follow-up was 47 months, 52 patients (14%) had a refracture (22 hip) and 129 (34.5%) died. AOM was started in 283 patients (76.0%). Factors associated with initiation of AOM were previous use of bisphosphonate (OR 9.94; 95% CI 1.29–76.32) and a lower T-score lumbar (OR 0.80; 95% CI 0.65–0.99). Persistence decreased to 72.6%, 60% and 47% at 12, 36 and 60 months. A PDC > 80% was confirmed in 208 patients (55.7%) and associated with previous use of bisphosphonate (OR 3.38; 95% CI 1.34–8.53), treatment with denosumab (OR 2.69; 95% CI:1.37–5.27), and inpatient identification (OR 2.26; 95% CI 1.18–4.34). Long-term persistence with AOM was optimal in patients with hip fracture seen at an FLS. A PDC > 80% was associated with inpatient identification and prescription of denosumab.

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The Fracture Liaison Service of the Virgen Macarena University Hospital Reduces the Gap in the Management of Osteoporosis, Particularly in Men. It Meets the International Osteoporosis Foundation Quality Standards

Cited by 7 publications

References 38 publications

Characterization and effectiveness of a Fracture Liaison Services program in Colombia

Characterization and effectiveness of a Fracture Liaison Services program in Colombia

Cost-Effectiveness Analysis of Fracture Liaison Services Compared with Standard of Care in the Secondary Prevention of Fragility Fractures in Spain

Long-term persistence of treatment after hip fracture in a fracture liaison service

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