Top

Published in:

Open Access 01-12-2023 | Denosumab | Original Article

Characterization and effectiveness of a Fracture Liaison Services program in Colombia

Authors: Luis Fernando Valladales-Restrepo, Edgar Eduardo Castro-Osorio, Jessica Ramírez-Osorio, Luisa Fernanda Echeverry-Martinez, Verónica Sánchez-Ríos, Andrés Gaviria-Mendoza, Manuel Enrique Machado-Duque, Jorge Enrique Machado-Alba

Published in: Archives of Osteoporosis | Issue 1/2023

Abstract

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.

Available only for authorised users

Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393(10169):364–376. https://doi.org/10.1016/S0140-6736(18)32112-3CrossRefPubMed

Dimai HP, Fahrleitner-Pammer A (2022) Osteoporosis and Fragility Fractures: currently available pharmacological options and future directions. Best Pract Res Clin Rheumatol 36(3):101780. https://doi.org/10.1016/j.berh.2022.101780CrossRefPubMed

Gopinath V (2023) Osteoporosis. Med Clin North Am 107(2):213–225. https://doi.org/10.1016/j.mcna.2022.10.013CrossRefPubMed

GBD (2019) Fracture Collaborators (2021) Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Healthy Longev 2(9):e580–e592. https://doi.org/10.1016/S2666-7568(21)00172-0CrossRef

Ganda K (2021) Fracture liaison services: past, present and future : Editorial relating to: The impact of Fracture Liaison Services on subsequent fractures and mortality: a systematic literature review and meta-analysis. Osteoporos Int 32(8):1461–1464. https://doi.org/10.1007/s00198-021-05982-8CrossRefPubMed

Medina Orjuela A, Rosero Olarte Ó, Nel Rueda Plata P, Sánchez Escobar F, Chalem Choueka M, González Reyes MÁ et al (2018) II Consenso Colombiano para el Manejo de la Osteoporosis Posmenopáusica. Rev Colomb Reumatol 25(3):184–210. https://doi.org/10.1016/j.rcreu.2018.02.006CrossRef

Åkesson KE, Ganda K, Deignan C, Oates MK, Volpert A, Brooks K, Lee D, Dirschl DR, Singer AJ (2022) Post-fracture care programs for prevention of subsequent fragility fractures: a literature assessment of current trends. Osteoporos Int 33(8):1659–1676. https://doi.org/10.1007/s00198-022-06358-2CrossRefPubMedPubMedCentral

Wu CH, Tu ST, Chang YF, Chan DC, Chien JT, Lin CH, Singh S, Dasari M, Chen JF, Tsai KS (2018) Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis. Bone 111:92–100. https://doi.org/10.1016/j.bone.2018.03.018CrossRefPubMed

Javaid MK, Sami A, Lems W, Mitchell P, Thomas T, Singer A, Speerin R, Fujita M, Pierroz DD, Akesson K, Halbout P, Ferrari S, Cooper C (2020) 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. Osteoporos Int 31(7):1193–1204. https://doi.org/10.1007/s00198-020-05377-1CrossRefPubMedPubMedCentral

10.

Sánchez MA, Segura JE, Alajmo G, Nossa JM, Correa A, Leal E, Moscoso A, Pineda GA, Aya AC (2020) Implementation of a Postfracture Care Program in a Private Hospital in Colombia. J Osteoporos 18(2020):8208397. https://doi.org/10.1155/2020/8208397CrossRef

11.

Medina A, Altamar G, Fernández-Ávila DG, Leal J, Castro E, Rivera A et al (2021) Clinical characteristics and impact of treatment gap of fragility fractures in Colombia: experience of 10 Fracture Liaison Services (FLS). J Gerontol Geriatr 69:147–54. https://doi.org/10.36150/2499-6564-N307CrossRef

12.

Chotiyarnwong P, Kitcharanant N, Vanitcharoenkul E, Anusitviwat C, Jarusriwanna A, Suthutvoravut W, Boonnasa W, Unnanuntana A (2023) Three-year outcomes of a fracture liaison service model at a university-based tertiary care hospital in Thailand. Arch Osteoporos 18(1):26. https://doi.org/10.1007/s11657-023-01215-zCrossRefPubMedPubMedCentral

13.

Chang CB, Yang RS, Chang LY, Peng JK, Tsai KS, Huang WJ, Yang TH, Chan DC (2019) Fracture types affect clinical outcomes of patients managed within the fracture liaison and osteoporosis medication management services. Sci Rep 9(1):10089. https://doi.org/10.1038/s41598-019-46315-4CrossRefPubMedPubMedCentral

14.

Chao CT, Yang RS, Huang WJ, Tsai KS, Chan DD (2019) Risk Factors for Poor Functional Recovery, Mortality, Recurrent Fractures, and Falls Among Patients Participating in a Fracture Liaison Service Program. J Am Med Dir Assoc 20(9):1129-1136.e1. https://doi.org/10.1016/j.jamda.2018.12.011CrossRefPubMed

15.

Delbar A, Pflimlin A, Delabrière I, Ternynck C, Chantelot C, Puisieux F, Cortet B, Paccou J (2021) Persistence with osteoporosis treatment in patients from the Lille University Hospital Fracture Liaison Service. Bone 144:115838. https://doi.org/10.1016/j.bone.2020.115838CrossRefPubMed

16.

Or O, Fisher Negev T, Hadad V, Shabtai R, Katzir A, Weil Y, Liebergall M (2021) Fracture Liaison Service for Hip Fractures: Is It A Game Changer? Isr Med Assoc J 23(8):490–493PubMed

17.

Valladales-Restrepo LF, Durán-Lengua M, Castro-Osorio E, Correa-Sánchez Y, Machado-Alba JE (2020) Sociodemographic, clinical and pharmacological characteristics of older adults with fractures, in three reference centers, Colombia. CES Medicina 34:14–26. https://doi.org/10.21615/cesmedicina.34.1.2CrossRef

18.

Ross BJ, Lee OC, Harris MB, Dowd TC, Savoie FH 3rd, Sherman WF (2021) Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures. JB JS Open Access 6(2):e20.00142. https://doi.org/10.2106/JBJS.OA.20.00142CrossRefPubMedPubMedCentral

19.

Pflimlin A, Gournay A, Delabrière I, Chantelot C, Puisieux F, Cortet B, Paccou J (2019) Secondary prevention of osteoporotic fractures: evaluation of the Lille University Hospital’s Fracture Liaison Service between January 2016 and January 2018. Osteoporos Int 30(9):1779–1788. https://doi.org/10.1007/s00198-019-05036-0CrossRefPubMed

20.

Lüthje P, Nurmi-Lüthje I, Tavast N, Villikka A, Kataja M (2021) Evaluation of minimal fracture liaison service resource: costs and survival in secondary fracture prevention-a prospective one-year study in South-Finland. Aging Clin Exp Res 33(11):3015–3027. https://doi.org/10.1007/s40520-021-01826-xCrossRefPubMedPubMedCentral

21.

Li N, van Oostwaard M, van den Bergh JP, Hiligsmann M, Boonen A, van Kuijk SMJ, Vranken L, Bours SPG, Wyers CE (2022) Health-related quality of life of patients with a recent fracture attending a fracture liaison service: a 3-year follow-up study. Osteoporos Int 33(3):577–588. https://doi.org/10.1007/s00198-021-06204-xCrossRefPubMed

22.

Inácio AM, Marques LLM, Borba VZC, Moreira CA (2022) Incidence of fractures and clinical profile of patients following up at a Fracture Liaison Service in the city of Curitiba. Aging Clin Exp Res 34(8):1885–1891. https://doi.org/10.1007/s40520-022-02116-wCrossRefPubMedPubMedCentral

23.

Olmo-Montes FJ, Hernández-Cruz B, Miranda MJ, Jimenez-Moreno MD, Vázquez-Gámez MÁ, Giner M, Colmenero MA, Pérez-Venegas JJ, Montoya-García MJ (2021) 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. J Clin Med 10(18):4220. https://doi.org/10.3390/jcm10184220CrossRefPubMedPubMedCentral

24.

Naranjo A, Molina A, Quevedo A, Rubiño FJ, Sánchez-Alonso F, Rodríguez-Lozano C, Ojeda S (2021) Fracture liaison service model: treatment persistence 5 years later. Arch Osteoporos 16(1):60. https://doi.org/10.1007/s11657-021-00925-6CrossRefPubMed

25.

González-Quevedo D, Pérez-Del-Río V, Moriel-Garceso D, Fernández-Arroyabe N, García-Meléndez G, Montañez-Ruiz M, Bravo-Bardají M, García-de-Quevedo D, Tamimi I (2022) A 2-year follow-up of a novel Fracture Liaison Service: can we reduce the mortality in elderly hip fracture patients? A prospective cohort study. Osteoporos Int 33(8):1695–1702. https://doi.org/10.1007/s00198-022-06298-xCrossRefPubMedPubMedCentral

26.

Fernández-Ávila DG, Rincón-Riaño DN, Pinzón DF, Gutiérrez Dávila JM (2019) Low rate of densitometric diagnosis and treatment in patients with severe osteoporosis in Colombia. Arch Osteoporos 14(1):95. https://doi.org/10.1007/s11657-019-0646-6CrossRefPubMed

27.

Valladales-Restrepo LF, Vargas-Diaz K, Peña-Verjan NM, Jaramillo-Sepúlveda S, Machado-Alba JE (2022) Pharmacological management, and potentially inappropriate prescriptions in patients with osteoporosis. Expert Rev Endocrinol Metab 17(5):455–462. https://doi.org/10.1080/17446651.2022.2112177CrossRefPubMed

28.

Scholten DJ 2nd, Bray JK, Wang KY, Lake AF, Emory CL (2020) Implementation of a fracture liaison service and its effects on osteoporosis treatment adherence and secondary fracture at a tertiary care academic health system. Arch Osteoporos 15(1):80. https://doi.org/10.1007/s11657-020-00736-1CrossRefPubMed

29.

Bergh C, Wennergren D, Möller M, Brisby H (2020) Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. PLoS ONE 15(12):e0244291CrossRefPubMedPubMedCentral

30.

Ortona E, Pagano MT, Capossela L, Malorni W (2023) The Role of Sex Differences in Bone Health and Healing. Biology 12(7):993CrossRefPubMedPubMedCentral

31.

American College of Obstetricians and Gynecologists’ Committee on Clinical Practice Guidelines–Gynecology (2021) Osteoporosis Prevention, Screening, and Diagnosis: ACOG Clinical Practice Guideline No. 1. Obstet Gynecol 138(3):494–506. https://doi.org/10.1097/AOG.0000000000004514CrossRef

32.

Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, Aguilar-Navarro S, Alexander NB, Becker C, Blain H, Bourke R, Cameron ID, Camicioli R, Clemson L, Close J, Delbaere K, Duan L, Duque G, Dyer SM, Freiberger E, Ganz DA, Gómez F, Hausdorff JM, Hogan DB, Hunter SMW, Jauregui JR, Kamkar N, Kenny RA, Lamb SE, Latham NK, Lipsitz LA, Liu-Ambrose T, Logan P, Lord SR, Mallet L, Marsh D, Milisen K, Moctezuma-Gallegos R, Morris ME, Nieuwboer A, Perracini MR, Pieruccini-Faria F, Pighills A, Said C, Sejdic E, Sherrington C, Skelton DA, Dsouza S, Speechley M, Stark S, Todd C, Troen BR, van der Cammen T, Verghese J, Vlaeyen E, Watt JA, Masud T, Task Force on Global Guidelines for Falls in Older Adults (2022) World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 51(9):205. https://doi.org/10.1093/ageing/afac205CrossRef

33.

Riancho JA, Peris P, González-Macías J, Pérez-Castrillón JL, SEIOMM Osteoporosis Guidelines Writing Group (2022) Executive summary clinical practice guideline of postmenopausal, glucocortcioid-induced and male osteoporosis (2022 update). Spanish Society for Bone and Mineral Metabolism Investigation (SEIOMM). Rev Clin Esp (Barc) 222(7):432–439. https://doi.org/10.1016/j.rceng.2021.12.008CrossRefPubMed

34.

Lee JC, Lee CH, Chung DW, Lee HJ, Park JY (2020) Analysis of Age-Based Bone Mineral Density in the Korean Adult Population Using Dual-Energy X-ray Absorptiometry. Appl Sci 10(23):8469CrossRef

35.

Healthcare Quality Improvement Partnership. Fracture Liaison Service Database. Annual report: Variable resilience of FLSs during the COVID-19 pandemic. Data from January to December 2020. Available on: https://www.hqip.org.uk/resource/fracture-liaison-service-database-annual-report/#.Y-6M_HbMI2w. Accessed: 1 March 2023

36.

Javaid MK, Calo M, Wullich S, Mohsin Z, Osorio EC, Orjuela AM, Unigarro CA, Mendez Sanchez L, Naranjo JT, Vieira LT, Tutiya KK, Inacio AM, de Leon AO, García JCV, Habib C, Subies F, Guyot JP, Diehl M, Carabelli G, Soulie A, Cooper C (2023) Development, implementation and evaluation of a multinational FLS mentorship programme in Latin America. Osteoporos Int. https://doi.org/10.1007/s00198-023-06742-6CrossRefPubMedPubMedCentral

37.

Rojas LGP, Cervantes REL, Almejo LL, Pesciallo CA, Garabano G, Bidolegui F et al (2022) Fragility fracture systems, Latin America perspective. OTA Int 5(3 Suppl):e178CrossRefPubMedPubMedCentral

38.

Johansen A, Ojeda-Thies C, Poacher AT, Hall AJ, Brent L, Ahern EC et al (2022) Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons. Bone Joint J 104-b(6):721–8CrossRefPubMedPubMedCentral

Title: Characterization and effectiveness of a Fracture Liaison Services program in Colombia
Authors: Luis Fernando Valladales-Restrepo
Edgar Eduardo Castro-Osorio
Jessica Ramírez-Osorio
Luisa Fernanda Echeverry-Martinez
Verónica Sánchez-Ríos
Andrés Gaviria-Mendoza
Manuel Enrique Machado-Duque
Jorge Enrique Machado-Alba
Publication date: 01-12-2023
Publisher: Springer London
Keywords: Denosumab
Osteoporosis
Osteoporosis
Denosumab
Published in: Archives of Osteoporosis / Issue 1/2023
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-023-01331-w

At a glance: The STEP trials

Springer Medicine

Characterization and effectiveness of a Fracture Liaison Services program in Colombia

Abstract

Purpose

Methods

Results

Conclusions

Summary

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Summary

Please log in to get access to this content

Other articles of this Issue 1/2023

Association between exercise and risk of fractures in new-onset type 2 diabetes: a retrospective cohort study

Bracing and taping interventions for individuals with vertebral fragility fractures: a systematic review of randomized controlled trials with GRADE assessment

The osteoporosis treatment gap in Switzerland between 1998 and 2018

The effects of abaloparatide on hip geometry and biomechanical properties in Japanese osteoporotic patients assessed using DXA-based hip structural analysis: results of the Japanese phase 3 ACTIVE-J trial

Effects of robot-assisted minimally invasive surgery on osteoporotic vertebral compression fracture: a systematic review, meta-analysis, and meta-regression of retrospective study

Decreasing incidence rates of osteoporotic hip fractures in Ecuador during the COVID-19 pandemic