Value of a coordinated management of osteoporosis via Fracture Liaison Service for the treatment of orthogeriatric patients

Schray, Deborah; Neuerburg, Carl; Stein, James H.; Gosch, M.; Schieker, Matthias; Böcker, Wolfgang; Kammerlander, Christian

doi:10.1007/s00068-016-0710-5

Cited by 23 publications

(16 citation statements)

References 24 publications

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“…Regarding secondary fracture prevention, both hospital sides provide a fracture liaison service (FLS), which coordinates diagnostics, treatment initiation and continuity for an underlying osteoporosis. Patients who suffer a fragility fracture and present with special risk factors for an osteoporosis are included and guideline adapted treatment is recommended [21]. Therefore, the detected rate of osteoporosis assessments is comparable in both hospital sites.…”

Section: Discussionmentioning

confidence: 99%

Orthogeriatric treatment reduces potential inappropriate medication in older trauma patients: a retrospective, dual-center study comparing conventional trauma care and co-managed treatment

et al. 2019

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BackgroundMultimorbidity and polypharmacy are common challenges in the treatment of older trauma patients. Therefore, various integrated care models were developed over the last few years, merging the expertise of geriatricians and trauma surgeons. The aim of this study was to evaluate, if the number of prescriptions of potentially inappropriate medication (PIM) could be reduced in these patients by an interdisciplinary co-managed concept compared to conventional trauma care.MethodsWe conducted a retrospective, dual-center cohort study, including all patients aged 70 years and older admitted with a fracture of the hip or the proximal humerus within the study period. Patients were treated in the universities department of trauma surgery with two different hospital sites, one with conventional trauma care (CTC) and the other one with a certified orthogeriatric trauma unit (OGC). Based on the STOPP/START criteria by O´Mahony et al., PIMs were defined, which should be avoided in (ortho)geriatric patients. Medical records of each patient were analyzed at discharge. Besides patients basic information, all prescribed drugs, changes in the medication plan and who carried out these changes were collected. For statistical analysis based on the data quality and distribution, the t test, Mann–Whitney U test and the Chi-square test were used.ResultsA total of 95 patients were included, 73 of them females, with an average age of 82.59 years (SD ± 6.96). Mean length of hospital stay was 12.98 at CTC and 13.36 days at OGC (p = 0.536). Among conventional care (41 patients), prescription of one or more PIMs was found in 85.4% of the patients, whereas at the orthogeriatric ward (54 patients) only in 22.2% (p < 0.001). Besides that, changes in medication were made for 48.1% of the patients during their stay on the orthogeriatric ward.ConclusionsOur findings show that an integrated care concept can reduce the number of prescriptions of PIMs significantly and potentially avoids adverse drug reactions and additional burdens in older trauma patients.

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Section: Discussionmentioning

confidence: 99%

Orthogeriatric treatment reduces potential inappropriate medication in older trauma patients: a retrospective, dual-center study comparing conventional trauma care and co-managed treatment

et al. 2019

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“…A growing body of published evidence suggests [74] that FLSs are a cost-effective care delivery model that has the potential to reduce the risk of refracture, increase the number of high-risk patients being treated and improve adherence to treatment. [71][72][73][74][75][76][77].…”

Section: Fracture Liaison Servicesmentioning

confidence: 99%

Fragility fractures in Europe: burden, management and opportunities

et al. 2020

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This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years. Introduction Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6). Methods A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric. Results Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided. Conclusions Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.

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“…ximalen Femurfrakturen auch die Einleitung der Sekundärprophylaxe unerlässlich. Eine besonders wichtige Stellung hat ein Fracture Liaison Service (FLS) in diesem Zusammenhang [17]. Eine Number needed to treat von 20, um eine Fraktur in 3 Jahren zu verhindern, belegt die Effektivität dieser Einrichtungen [18].…”

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