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Fracture Liaison Service

Chih-Hsing Wu, Shih-Te Tu, Yin-Fan Chang, Ding-Cheng Chan, Jui-Teng Chien, Chih-Hsueh Lin, Sonal Singh, Manikanta Dasari, Jung-Fu Chen, Keh-Sung Tsai
OBJECTIVES: This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. METHODS: Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000-February 2017 inclusive) using the keywords 'osteoporosis,' 'fractures,' 'liaison,' and 'service' to identify randomised controlled trials and observational studies of patients aged ≥50 years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS...
March 16, 2018: Bone
Patricia A Mackey, Laura D Rosenthal, Lanyu Mi, Michael D Whitaker
Because of osteoporosis, patients older than 50 years with fragility fractures are at risk of further fractures. We developed a quality improvement initiative based on an evidence-based Fracture Liaison Service (FLS) model of care to help prevent subsequent fractures. Previous to the implemented FLS model, less than 13% of patients with fragility fractures were assessed for osteoporosis at our institution. We created a registry tool to identify patients with fractures who were older than 50 years. Our interventions focused on identifying, contacting, and educating patients; and coordinating screening tests and an outpatient follow-up visit with an endocrinologist...
March 16, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
M Chandran, D Tay, X F Huang, Y Hao
Hospital care and mortality of diabetic and non-diabetic osteoporotic Asian patients undergoing hip fracture surgery were explored with no difference in length of hospitalization, incidence of post-operative complications, or mortality between diabetics and non-diabetics seen. Time to operation correlated with post-operative complications occurrence and therefore surgery should be expeditiously done. INTRODUCTION: Whether burden of inpatient care, problems after admission, and mortality rates differ between diabetics and non-diabetics undergoing surgery for osteoporotic hip fractures has not been explored in Asian populations...
March 15, 2018: Archives of Osteoporosis
C-H Wu, C-H Chen, P-H Chen, J-J Yang, P-C Chang, T-C Huang, S Bagga, Y Sharma, R-M Lin, D-C Chan
Fracture liaison services (FLS) have been demonstrated to improve outcomes following osteoporotic fracture. The aim of this systematic literature review (SLR) was to determine the characteristics of an FLS that lead to improved patient outcomes. We conducted a SLR, including articles published between 2000 and February 2017, using global (Medline, EMBASE, PubMed and Cochrane Library) and local databases. Studies including patients aged ≥ 50 years with osteoporotic fractures enrolled in an FLS were assessed...
March 10, 2018: Osteoporosis International
C-H Wu, I-J Kao, W-C Hung, S-C Lin, H-C Liu, M-H Hsieh, S Bagga, M Achra, T-T Cheng, R-S Yang
Fracture liaison services (FLS), implemented in different ways and countries, are reported to be a cost-effective or even a cost-saving secondary fracture prevention strategy. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. This study summarizes the economic impact and cost-effectiveness of FLS implemented to reduce subsequent fractures in individuals with osteoporosis. This systematic review identified studies reporting economic outcomes for FLS in osteoporotic patients aged 50 and older through a comprehensive search of MEDLINE, EMBASE, Cochrane Central, and PubMed of studies published January, 2000 to December, 2016...
February 19, 2018: Osteoporosis International
S L Greenspan, A Singer, K Vujevich, B Marchand, D A Thompson, Y-J Hsu, D Vaidya, L S Stern, D Zeldow, D B Lee, S Karp, R Recker
PURPOSE: Although half of women and one-quarter of men aged 50 and older will sustain an acute low-trauma fracture, less than a quarter receive appropriate secondary fracture prevention. The goal of this quality improvement demonstration project was to implement a Fracture Liaison Service (FLS) focused on secondary prevention of an osteoporotic fracture in three open health care systems aided by a cloud-based tool. METHODS: The pre-post study design examined the proportion of men and women over age 50 who received appropriate assessment (bone mineral density, vitamin D levels) and treatment (calcium/vitamin D, pharmacologic therapy) in the six months following a recently diagnosed fracture...
February 10, 2018: Osteoporosis International
Bérengère Aubry-Rozier, Delphine Stoll, Elena Gonzalez Rodriguez, Didier Hans, Veronique Prudent, Ariane Seuret, Alain Farron, Olivier Lamy
In 2008, the Centre Hospitalier Universitaire Vaudois (CHUV, Lausanne, Switzerland) initiated a Fracture Liaison Service (FLS). All patients hospitalised for a low trauma fracture are identified by the FLS. Inpatients then choose to be managed by either the FLS team or their general practitioner (GP). In this study we compared the management between the FLS team and the GP in terms of diagnosis of osteoporosis, treatment, refracture rates and mortality after FLS recording. Results are compared with the management of osteoporosis before the creation of the FLS, as reported in the survey study Osteocare...
January 29, 2018: Swiss Medical Weekly
Y -F Chang, C -F Huang, J -S Hwang, J -F Kuo, K -M Lin, H -C Huang, S Bagga, A Kumar, F -P Chen, C -H Wu
The analysis aimed to identify the treatment gaps in current fracture liaison services (FLS) and to provide recommendations for best practice establishment of future FLS across the Asia-Pacific region. The findings emphasize the unmet need for the implementation of new programs and provide recommendations for the refinement of existing ones. The study's objectives were to evaluate fracture liaison service (FLS) programs in the Asia-Pacific region and provide recommendations for establishment of future FLS programs...
December 28, 2017: Osteoporosis International
P van den Berg, P M M van Haard, E van der Veer, P P Geusens, J P van den Bergh, D H Schweitzer
Telephone call intervention did not improve alendronate persistence in Fracture Liaison Service (FLS) patients in this study. A bone turnover marker cut-off point for alendronate persistence is proposed for individual FLS patients. INTRODUCTION: FLS aims to prevent subsequent fractures, which should include improving patients' persistence with prescribed oral bisphosphonates. We studied the influence of telephone calls and the predictive value of changes in bone turnover markers (BTMs) for evaluating persistence with alendronate...
December 19, 2017: Osteoporosis International
Antonio Naranjo, Sonia Fernández-Conde, Soledad Ojeda, Laura Torres-Hernández, Carolina Hernández-Carballo, Idoia Bernardos, Sinforiano Rodríguez, Pedro Laynez
An observational study was carried out in two hospitals in patients > 65 years admitted for hip fracture. At 6 months, 15% of patients in the hospital with orthogeriatric standard care and 75% in the hospital with fracture liaison service were receiving bisphosphonates. PURPOSE: Many patients with fractures are discharged without preventive therapy against further fractures. We sought to compare the effectiveness of an orthogeriatric fracture liaison service (FLS), outpatient FLS, and the standard care after hip fractures in prevention of future fractures...
December 11, 2017: Archives of Osteoporosis
Lídia Sànchez-Riera, Nicholas Wilson
Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective...
April 2017: Best Practice & Research. Clinical Rheumatology
Eng Keong Tan, Kah Poh Loh, Sarah L Goff
OBJECTIVES: Osteoporosis is a major public health concern affecting an estimated 10 million people in the United States. To the best of our knowledge, no qualitative study has explored barriers perceived by medicine hospitalists to secondary prevention of osteoporotic hip fractures. We aimed to describe these perceived barriers and recommendations regarding how to optimize secondary prevention of osteoporotic hip fracture. METHODS: In-depth, semistructured interviews were performed with 15 internal medicine hospitalists in a tertiary-care referral medical center...
December 2017: Southern Medical Journal
L Vranken, C E Wyers, R Y Van der Velde, H M Janzing, S Kaarsemaker, P P Geusens, J P Van den Bergh
In this cross-sectional study, two-thirds of Fracture Liaison Service (FLS) patients had comorbidities and medications associated with increased bone- or fall-related fracture risk. Bone-related and fall-related fracture risk (BRR and FRR) were associated with age and fracture type, but not with gender or BMD. Systematic evaluation of these factors leads to a more profound assessment in FLS care. INTRODUCTION: This study is a systematic evaluation of comorbidities and medications associated with increased fracture risk in patients aged 50-90 years with a recent fracture visiting the FLS...
February 2018: Osteoporosis International
Roman Lorenc, Piotr Głuszko, Edward Franek, Mirosław Jabłoński, Maciej Jaworski, Ewa Kalinka-Warzocha, Elzbieta Karczmarewicz, Tomasz Kostka, Krystyna Księzopolska-Orłowska, Ewa Marcinowska-Suchowierska, Waldemar Misiorowski, Andrzej Więcek
In the rapidly ageing society in Poland, osteoporosis is a growing epidemiological problem, and osteoporosis-related fractures are a cause of chronic disability and considerable increase of death risk. It turns out that 80 to 90% of patients suffering from osteoporosis, including osteoporosis accompanied by fractures, do not receive adequate pharmacotherapy. In this paper, a Guideline Working Group of experts from the Multidisciplinary Osteoporosis Forum update the existing Polish guidelines concerning the diagnosis and management of osteoporosis (last revised in 2013), taking account of the latest literature, availability and reimbursement of drugs, and current health care organisation...
2017: Endokrynologia Polska
P Dunn, D Webb, T P Olenginski
Geisinger Health System (GHS) high-risk osteoporosis clinic (HiROC), which treats patients with low-trauma, fragility fractures, reports their 2013-2015 performance measures in secondary fracture prevention. This fracture liaison service (FLS) pathway treats 75% of high-risk, drug eligible patients, compared to 13.8% in GHS primary care. This performance points to the need for more FLS programs throughout the world. INTRODUCTION: The purpose of this study is to analyze and report ongoing performance measures in outpatient and inpatient high-risk osteoporosis clinic (HiROC) program designed for patients with low-trauma, fragility fractures...
October 23, 2017: Osteoporosis International
Umberto Tarantino, Giovanni Iolascon, Luisella Cianferotti, Laura Masi, Gemma Marcucci, Francesca Giusti, Francesca Marini, Simone Parri, Maurizio Feola, Cecilia Rao, Eleonora Piccirilli, Emanuela Basilici Zanetti, Noemi Cittadini, Rosaria Alvaro, Antimo Moretti, Dario Calafiore, Giuseppe Toro, Francesca Gimigliano, Giuseppina Resmini, Maria Luisa Brandi
BACKGROUND: The Italian Society for Orthopaedics and Traumatology conceived this guidance-which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners-in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences. MATERIALS AND METHODS: Literature reviews by a multidisciplinary team. RESULTS: The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention...
November 2017: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
J W A M den Teuling, B S Pauwels, L Janssen, C E Wyers, H M J Janzing, J P W van den Bergh, J W Morrenhof
OBJECTIVES: The goal of this study is to investigate the relation between indicators of osteoporosis (i.e., bone mineral density (BMD), and Cortical Index (CI)) and the complexity of a fracture of the proximal humerus as a result of a low-energy trauma. METHODS: A retrospective chart review of 168 patients (mean age 67.2 years, range 51 to 88.7) with a fracture of the proximal humerus between 2007 and 2011, whose BMD was assessed at the Fracture Liaison Service with Dual Energy X-ray Absorptiometry (DXA) measurements of the hip, femoral neck (FN) and/or lumbar spine (LS), and whose CI and complexity of fracture were assessed on plain anteroposterior radiographs of the proximal humerus...
October 2017: Bone & Joint Research
A Frederiksen, B Abrahamsen, P B Johansen, H A Sørensen
Fracture liaison services prevent hip fractures by identifying other osteoporotic fractures that generally debut at a younger age. However, this study showed that a minority of hip fracture patients are already known to the health services through having had prior osteoporotic fractures. Identification of vertebral fractures in particular is lacking. INTRODUCTION: The purpose of this study was to examine the prevalence of prior major osteoporotic fractures (MOF) in the prior 10 years preceding hip fracture in order to provide information about the potential for prevention of hip fractures by fracture liaison services (FLS)...
September 30, 2017: Osteoporosis International
Falah Bachour, Maroun Rizkallah, Amer Sebaaly, Angelique Barakat, Hiba Razzouk, Rawad El Hage, Riad Nasr, Mirvat El Khoury, Ghassan Maalouf
This study aims to assess for the first time in the Middle East, the clinical benefits of an FLS model established in a hospital in Beirut, Lebanon. It shows a significant 54% relative risk reduction in re-fracture incidence, confirming the patient-oriented benefit of diffusing this system in the Middle East region. PURPOSE/INTRODUCTION: Few hospitals in Lebanon applied Fracture Liaison Service (FLS) program. A type A FLS is established at Bellevue hospital in Beirut in July 2013. This study aims to assess its clinical benefits and efficacy...
September 19, 2017: Archives of Osteoporosis
Shahryar Noordin, Salim Allana, Bassam A Masri
In the aging population worldwide, osteoporosis is a relatively common condition and a major cause of long-term morbidity. Initial fragility fractures can lead to subsequent fractures. After a vertebral fracture, the risk of any another fracture increases 200% and that of a subsequent hip fracture increases 300%. For starting a hospital based Fracture Liaison Service (FLS) program, the nucleus is based on a physician champion, a FLS coordinator, and a nurse manager. A Fracture Liaison Service (FLS) is a multidisciplinary system approach to reducing subsequent fracture risk in patients with a recent fragility fracture due to compromised bone health by identifying them at or close to the time when they are treated at the hospital for fracture and providing them with easy access to osteoporosis care...
September 12, 2017: International Journal of Surgery
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