The role of the Fracture Liaison Service (FLS) in subsequent fracture prevention in the extreme elderly

Sanli, Ilknur; Helden, Sven H. van; Broeke, René H.M. ten; Geusens, Piet; Bergh, Joop van den; Brink, Peter R.; Poeze, Martijn

doi:10.1007/s40520-018-1054-2

Cited by 21 publications

(28 citation statements)

References 43 publications

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“…Evidence shows that FLS programs, especially Type A, are efficient. They have demonstrated to increase the diagnosis of osteoporosis—up to 80%—, lower the risk of refracture (30–40%), and reduce both costs and mortality [ 23 , 24 ]. A meta-analysis calculated that 20 patients would need to be treated to prevent one refracture within three years [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sánchez

Segura

Alajmo

et al. 2020

Journal of Osteoporosis

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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.

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Section: Discussionmentioning

confidence: 99%

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

Sánchez

Segura

Alajmo

et al. 2020

Journal of Osteoporosis

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“…The recommended age range for an FLS is 50 years and over with no upper limit, as even the elderly with established osteoporosis are more likely to survive long enough to sustain a subsequent fracture and benefit from AOM [41]. An FLS study comparing re-fracture rates in those aged over 85 years has questioned whether the competing risk of death substantially diminishes the capacity of an FLS to reduce fracture rates [58]. However, for elderly women aged 80 years or over, the risk of hip fracture in 5 years is high despite the competing risk of mortality [41,59].…”

Section: Discussionmentioning

confidence: 99%

A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network

et al. 2020

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The International Osteoporosis Foundation (IOF) Capture the Fracture® Campaign with the Fragility Fracture Network (FFN) and National Osteoporosis Foundation (NOF) has developed eleven patient-level key performance indicators (KPIs) for fracture liaison services (FLSs) to guide quality improvement. Introduction Fracture Liaison Services (FLSs) are recommended worldwide to reduce fracture risk after a sentinel fracture. Given not every FLS is automatically effective, the IOF Capture the Fracture working group has developed and implemented the Best Practice Framework to assess the organisational components of an FLS. We have now developed a complimentary KPI set that extends this assessment of performance to the patient level. Methods The Capture the Fracture working group in collaboration with the Fragility Fracture Network Secondary Fragility Fracture Special Interest Group and National Osteoporosis Foundation adapted existing metrics from the UK-based Fracture Liaison Service Database Audit to develop a patient-level KPI set for FLSs. Results Eleven KPIs were selected. The proportion of patients: with non-spinal fractures; with spine fractures (detected clinically and radiologically); assessed for fracture risk within 12 weeks of sentinel fracture; having DXA assessment within 12 weeks of sentinel fracture; having falls risk assessment; recommended anti-osteoporosis medication; commenced of strength and balance exercise intervention within 16 weeks of sentinel fracture; monitored within 16 weeks of sentinel fracture; started antiosteoporosis medication within 16 weeks of sentinel fracture; prescribed anti-osteoporosis medication 52 weeks after sentinel fracture. The final KPI measures data completeness for each of the other KPIs. For these indicators, levels of achievement were set at the < 50%, 50-80% and > 80% levels except for treatment recommendation where a level of 50% was used.

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“…Over this follow-up period, a 64% lower mortality risk was also observed [ 146 ]. In another study among patients aged over 85 years with a clinical fracture, a significant lower cumulative mortality was observed over 2 years in the FLS attenders group without a reduced subsequent fracture rate [ 147 ].…”

Section: Methodsmentioning

confidence: 99%

How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture?

et al. 2021

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In this narrative review, the role of vitamin D deficiency in the pathophysiology, healing of fragility fractures, and rehabilitation is discussed. Vitamin D status can be assessed by measuring serum 25(OH)-vitamin D level with standardized assays. There is a high prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l (i.e., 20 ng/mL)) or deficiency (25(OH)D < 25 nmol/l (i.e., 10 ng/mL)) in patients with fragility fractures and especially in those with a hip fracture. The evidence on the effects of vitamin D deficiency and/or vitamin D supplementation on fracture healing and material osseointegration is still limited. However, it appears that vitamin D have a rather positive influence on these processes. The fracture liaison service (FLS) model can help to inform orthopedic surgeons, all caregivers, and fractured patients about the importance of optimal vitamin D status in the management of patients with fragility fractures. Therefore, vitamin D status should be included in Capture the Fracture® program as an outcome of FLS in addition to dual-energy X-ray absorptiometry (DXA) and specific antiosteoporosis medication. Vitamin D plays a significant role in the pathophysiology and healing of fragility fractures and in rehabilitation after fracture. Correction of vitamin D deficiency should be one of the main outcomes in fracture liaison services.

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The role of the Fracture Liaison Service (FLS) in subsequent fracture prevention in the extreme elderly

Cited by 21 publications

References 43 publications

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

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

A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network

How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture?

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