Effectiveness of a minimal resource fracture liaison service
Tóm tắt
The purpose of this study was to investigate if a 2-year intervention with a minimal resource fracture liaison service (FLS) was associated with increased investigation and medical treatment and if treatment was related to reduced re-fracture risk. The FLS started in 2013 using existing secretaries (without an FLS coordinator) at the emergency department and orthopaedic wards to identify risk patients. All patients older than 50 years of age with a fractured hip, vertebra, shoulder, wrist or pelvis were followed during 2013–2014 (n = 2713) and compared with their historic counterparts in 2011–2012 (n = 2616) at the same hospital. Re-fractures were X-ray verified. A time-dependent adjusted (for age, sex, previous fracture, index fracture type, prevalent treatment, comorbidity and secondary osteoporosis) Cox model was used. The minimal resource FLS increased the proportion of DXA-investigated patients after fracture from 7.6 to 39.6 % (p < 0.001) and the treatment rate after fracture from 12.6 to 31.8 %, which is well in line with FLS types using the conventional coordinator model. Treated patients had a 51 % lower risk of any re-fracture than untreated patients (HR 0.49, 95 % CI 0.37–0.65 p < 0.001). We found that our minimal resource FLS was effective in increasing investigation and treatment, in line with conventional coordinator-based services, and that treated patients had a 51 % reduced risk of new fractures, indicating that also non-coordinator based fracture liaison services can improve secondary prevention of fractures.
Tài liệu tham khảo
Murray CJ, Barber RM, Foreman KJ et al (2015) Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet (Lond, Engl). doi:10.1016/s0140-6736(15)61340-x
Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Lunsjo K, Thorngren KG, Sernbo I, Rehnberg C, Jonsson B (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17(5):637–650. doi:10.1007/s00198-005-0015-8
Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367(9527):2010–2018. doi:10.1016/s0140-6736(06)68891-0
Sattui SE, Saag KG (2014) Fracture mortality: associations with epidemiology and osteoporosis treatment. Nat Rev Endocrinol 10(10):592–602. doi:10.1038/nrendo.2014.125
Lorentzon M, Cummings SR (2015) Osteoporosis: the evolution of a diagnosis. J Intern Med 277(6):650–661. doi:10.1111/joim.12369
Wells George A, Cranney A, Peterson J, Boucher M, Shea B, Welch V, Coyle D, Tugwell P (2008) Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev (1). doi:10.1002/14651858.CD001155.pub2
Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356(18):1809–1822. doi:10.1056/NEJMoa067312
Boonen S, Adachi JD, Man Z, Cummings SR, Lippuner K, Torring O, Gallagher JC, Farrerons J, Wang A, Franchimont N, San Martin J, Grauer A, McClung M (2011) Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab 96(6):1727–1736. doi:10.1210/jc.2010-2784
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739. doi:10.1359/jbmr.2000.15.4.721
Quality and Efficiency in Swedish Health Care - Regional Comparisons 2013 by the Swedish Association of Local Authorities and Regions (2013)
Sale JE, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2011) Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporos Int 22(7):2067–2082. doi:10.1007/s00198-011-1544-y
Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24(2):393–406. doi:10.1007/s00198-012-2090-y
Lih A, Nandapalan H, Kim M, Yap C, Lee P, Ganda K, Seibel MJ (2011) Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Osteoporos Int 22(3):849–858. doi:10.1007/s00198-010-1477-x
Astrand J, Nilsson J, Thorngren KG (2012) Screening for osteoporosis reduced new fracture incidence by almost half: a 6-year follow-up of 592 fracture patients from an osteoporosis screening program. Acta Orthop 83(6):661–665. doi:10.3109/17453674.2012.747922
Van der Kallen J, Giles M, Cooper K, Gill K, Parker V, Tembo A, Major G, Ross L, Carter J (2014) A fracture prevention service reduces further fractures two years after incident minimal trauma fracture. Int J Rheum Dis 17(2):195–203. doi:10.1111/1756-185X.12101
Huntjens KM, van Geel TA, van den Bergh JP, van Helden S, Willems P, Winkens B, Eisman JA, Geusens PP, Brink PR (2014) Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am 96(4):e29. doi:10.2106/JBJS.L.00223
Nakayama A, Major G, Holliday E, Attia J, Bogduk N (2015) Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate. Osteoporos Int. doi:10.1007/s00198-015-3443-0
Chen Z, Kooperberg C, Pettinger MB, Bassford T, Cauley JA, LaCroix AZ, Lewis CE, Kipersztok S, Borne C, Jackson RD (2004) Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Womenʼs Health Initiative observational study and clinical trials. Menopause 11(3):264–274. doi:10.1097/01.gme.0000094210.15096.fd
Ismail AA, O’Neill TW, Cockerill W, Finn JD, Cannata JB, Hoszowski K, Johnell O, Matthis C, Raspe H, Raspe A, Reeve J, Silman AJ (2000) Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS Study Group. European Prospective Osteoporosis Study Group. Osteoporos Int 11(3):248–254
Nevitt MC, Cummings SR, Browner WS, Seeley DG, Cauley JA, Vogt TM, Black DM (1992) The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 135(5):490–499
Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, McLellan AR, Mitchell PJ, Sale JE, Wahl DA (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22(7):2051–2065. doi:10.1007/s00198-011-1642-x
The National guidelines for Musculoskeletal Diseases by The National Board of Health and Welfare (2012)
Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95(3):1174–1181. doi:10.1210/jc.2009-0852
Dell R, Greene D, Schelkun SR, Williams K (2008) Osteoporosis disease management: the role of the orthopaedic surgeon. J Bone Joint Surg Am 90(Suppl 4):188–194. doi:10.2106/JBJS.H.00628
Kothawala P, Badamgarav E, Ryu S, Miller RM, Halbert RJ (2007) Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. Mayo Clin Proc 82(12):1493–1501. doi:10.1016/s0025-6196(11)61093-8