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Current Osteoporosis Reports
Published in: Current Osteoporosis Reports 1/2021

Open Access 01-02-2021 | Care | Epidemiology and Pathophysiology (D Shoback and G El-Hajj Fuleihan, Section Editors)

Closing the Osteoporosis Care Gap

Authors: Kristina E. Åkesson, Fiona E. A. McGuigan

Published in: Current Osteoporosis Reports | Issue 1/2021

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Abstract

Purpose of Review

This review outlines the scope of the problem in osteoporosis care and secondary fracture prevention and describes fracture prevention strategies, with a focus on the frail elderly.

Recent Findings

Despite heightened awareness among patients and clinicians alike and the availability of efficacious anti-osteoporosis medications, osteoporosis is still underdiagnosed and undertreated. However, the introduction of systematic risk assessment and secondary fracture prevention programmes has gained momentum, and evidence of success is accumulating.

Summary

We possess today the knowledge required to close the osteoporosis care gap. The basic components in a secondary prevention model are similar in all health care settings, number one being a dedicated fracture coordinator, with anti-osteoporosis medications and multifaceted falls prevention as cornerstones, particularly in the frailest, both in the near and long-term. Initiation of structured care pathways including the key elements – identification, investigation, intervention and follow-up of adherence – demonstrably reduces re-fracture rates and is cost-effective.
Literature
1.
Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145–54.PubMedCrossRef
2.
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15(4):721–39.PubMedCrossRef
3.
Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35(2):375–82.PubMedCrossRef
4.
Johansson H, Oden A, McCloskey EV, Kanis JA. Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures. Osteoporos Int. 2014;25(1):235–41.PubMedCrossRef
5.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.PubMedCrossRef
6.
7.
Toth E, Banefelt J, Åkesson K, Spångeus A, Ortsäter G, Libanati C. History of previous fracture and imminent fracture risk in Swedish women aged 55 to 90 years presenting with a fragility fracture. J Bone Miner Res. 2020;35(5):861–8.PubMedCrossRef
8.
•• Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, et al. Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int. 2013;24(2):393–406 This study clearly demonstrates that the intensity of the secondary fracture prevention programme plays a key role for the investigation and initiation of treatment.PubMedCrossRef
9.
•• Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, et al. Capture the fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24(8):2135–52 The Best Practice Framework describes the guiding standards to establish and improve a fracture liaison service applicable to any setting.PubMedPubMedCentralCrossRef
10.
•• Conley RB, Adib G, Adler RA, Akesson KE, Alexander IM, Amenta KC, et al. Secondary fracture prevention: consensus clinical recommendations from a multistakeholder coalition. J Bone Miner Res. 2020;35(1):36–52. These recommendations highlight the importance of patient communication in order to develop successful implementation of secondary fracture prevention, essential for adherence to treatment.
11.
de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.PubMedCrossRef
12.
Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc. 2013;61(9):1537–51.PubMedCrossRef
13.
Hyde Z, Flicker L, Almeida OP, Hankey GJ, McCaul KA, Chubb SA, et al. Low free testosterone predicts frailty in older men: the health in men study. J Clin Endocrinol Metab. 2010;95(7):3165–72.PubMedCrossRef
14.
Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Sci World J. 2001;1:323–36.CrossRef
15.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. Canadian Med Assoc Journal. 2005;173(5):489–95.CrossRef
16.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.PubMedCrossRef
17.
Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722–7.PubMedCrossRef
18.
Kojima G, Kendrick D, Skelton DA, Morris RW, Gawler S, Iliffe S. Frailty predicts short-term incidence of future falls among British community-dwelling older people: a prospective cohort study nested within a randomised controlled trial. BMC Geriatr. 2015;15:155.PubMedPubMedCentralCrossRef
19.
Gerdhem P, Ringsberg K, Akesson K, Obrant KJ. Just one look, and fractures and death can be predicted in elderly ambulatory women. Gerontology. 2004;50(5):309–14.PubMedCrossRef
20.
Roh YH, Noh JH, Gong HS, Baek GH. Effect of low appendicular lean mass, grip strength, and gait speed on the functional outcome after surgery for distal radius fractures. Arch Osteoporos. 2017;12(1):41.PubMedCrossRef
21.
Li G, Papaioannou A, Thabane L, Cheng J, Adachi JD. Frailty change and major osteoporotic fracture in the elderly: data from the global longitudinal study of osteoporosis in women 3-year Hamilton cohort. J Bone Miner Res. 2016;31(4):718–24.PubMedCrossRef
22.
Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ 3rd. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137(9):1001–5.PubMedCrossRef
23.
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone. 2003;32(5):468–73.PubMedCrossRef
24.
Pande I, Scott DL, O'Neill TW, Pritchard C, Woolf AD, Davis MJ. Quality of life, morbidity, and mortality after low trauma hip fracture in men. Ann Rheum Dis. 2006;65(1):87–92.PubMedCrossRef
25.
von Friesendorff M, McGuigan FE, Wizert A, Rogmark C, Holmberg AH, Woolf AD, et al. Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int. 2016;27(10):2945–53.
26.
Kojima G. Frailty as a predictor of fractures among community-dwelling older people: a systematic review and meta-analysis. Bone. 2016;90:116–22.PubMedCrossRef
27.
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.PubMedCrossRef
28.
29.
Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, et al. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int. 1999;65(3):183–7.PubMedCrossRef
30.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.PubMedCrossRef
31.
Li G, Ioannidis G, Pickard L, Kennedy C, Papaioannou A, Thabane L, et al. Frailty index of deficit accumulation and falls: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort. BMC Musculoskelet Disord. 2014;15:185.PubMedPubMedCentralCrossRef
32.
Bartosch P, McGuigan FE, Akesson KE. Progression of frailty and prevalence of osteoporosis in a community cohort of older women-a 10-year longitudinal study. Osteoporos Int. 2018;29(10):2191–9.PubMedPubMedCentralCrossRef
33.
Cook MJ, Oldroyd A, Pye SR, Ward KA, Gielen E, Ravindrarajah R, et al. Frailty and bone health in European men. Age Ageing. 2017;46(4):635–41.PubMed
34.
Egund L, McGuigan F, Onnby K, Giwercman A, Akesson K. High prevalence of osteoporosis in men with distal radius fracture: a cross-sectional study of 233 men. Calcif Tissue Int. 2016;99(3):250–8.PubMedCrossRef
35.
36.
Si L, Winzenberg TM, Jiang Q, Chen M, Palmer AJ. Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int. 2015;26(7):1929–37.PubMedCrossRef
37.
Lewiecki EM, Ortendahl JD, Vanderpuye-Orgle J, Grauer A, Arellano J, Lemay J, et al. Healthcare policy changes in osteoporosis can improve outcomes and reduce costs in the United States. JBMR Plus. 2019;3(9):e10192.PubMedPubMedCentralCrossRef
38.
Wu CH, Tu ST, Chang YF, Chan DC, Chien JT, Lin CH, et al. Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Bone. 2018;111:92–100.PubMedCrossRef
39.
Huntjens KM, van Geel TA, van den Bergh JP, van Helden S, Willems P, Winkens B, et al. Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am. 2014;96(4):e29.PubMedCrossRef
40.
41.
Boudou L, Gerbay B, Chopin F, Ollagnier E, Collet P, Thomas T. Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int. 2011;22(7):2099–106.PubMedCrossRef
42.
Eekman DA, van Helden SH, Huisman AM, Verhaar HJ, Bultink IE, Geusens PP, et al. Optimizing fracture prevention: the fracture liaison service, an observational study. Osteoporos Int. 2014;25(2):701–9.PubMedCrossRef
43.
Netelenbos JC, Geusens PP, Ypma G, Buijs SJ. Adherence and profile of non-persistence in patients treated for osteoporosis--a large-scale, long-term retrospective study in the Netherlands. Osteoporos Int. 2011;22(5):1537–46.PubMedCrossRef
44.
Kothawala P, Badamgarav E, Ryu S, Miller RM, Halbert RJ. Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. Mayo Clin Proc. 2007;82(12):1493–501.PubMedCrossRef
45.
Gamboa A, Duaso E, Marimon P, Sandiumenge M, Escalante E, Lumbreras C, et al. Oral bisphosphonate prescription and non-adherence at 12 months in patients with hip fractures treated in an acute geriatric unit. Osteoporos Int. 2018;29(10):2309–14.PubMedCrossRef
46.
Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;1:Cd012424.
47.
Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews. 2018;9:Cd005465.
48.
El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f6234.PubMedPubMedCentral
49.
Hopewell S, Adedire O, Copsey BJ, Boniface GJ, Sherrington C, Clemson L, et al. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2018;7:Cd012221.
50.
51.
Daniels R, van Rossum E, de Witte L, Kempen GI, van den Heuvel W. Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res. 2008;8:278.PubMedPubMedCentralCrossRef
52.
Faber MJ, Bosscher RJ, Chin APMJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Arch Phys Med Rehabil. 2006;87(7):885–96.PubMedCrossRef
53.
Serra-Prat M, Sist X, Domenich R, Jurado L, Saiz A, Roces A, et al. Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial. Age Ageing. 2017;1;46(3):401–407.
54.
Tikkanen P, Lonnroos E, Sipila S, Nykanen I, Sulkava R, Hartikainen S. Effects of comprehensive geriatric assessment-based individually targeted interventions on mobility of pre-frail and frail community-dwelling older people. Geriatr Gerontol Int. 2015;15(1):80–8.PubMedCrossRef
55.
Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database of Systematic Reviews. 2009;15;2009(2):CD003288.
56.
Lozano-Montoya I, Correa-Perez A, Abraha I, Soiza RL, Cherubini A, O'Mahony D, et al. Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: a systematic overview - the SENATOR Project ONTOP Series. Clin Interv Aging. 2017;12:721–40.PubMedPubMedCentralCrossRef
57.
Fairhall N, Kurrle SE, Sherrington C, Lord SR, Lockwood K, John B, et al. Effectiveness of a multifactorial intervention on preventing development of frailty in pre-frail older people: study protocol for a randomised controlled trial. BMJ Open. 2015;5(2):e007091.PubMedPubMedCentralCrossRef
58.
Fairhall N, Sherrington C, Kurrle SE, Lord SR, Lockwood K, Howard K, et al. Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people. J Am Med Dir Assoc. 2015;16(1):41–8.PubMedCrossRef
59.
Mitchell PJ, Cooper C, Fujita M, Halbout P, Akesson K, Costa M, et al. Quality improvement initiatives in fragility fracture care and prevention. Current osteoporosis reports. 2019;17:510–20.PubMedCrossRef
60.
Judge A, Javaid MK, Leal J, Hawley S, Drew S, Sheard S, et al. Health Services and Delivery Research. Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England. Health Serv Deliv Res. 2016;4(28).
61.
Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH, et al. Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture(R) Best Practice Framework tool. Osteoporos Int. 2015;26(11):2573–8.PubMedCrossRef
62.
Hawley S, Javaid MK, Prieto-Alhambra D, Lippett J, Sheard S, Arden NK, et al. Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study. Age Ageing. 2016;45(2):236–42.PubMedPubMedCentralCrossRef
63.
64.
Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian children and youth: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011;22(1):15–23.PubMed
Metadata
Title
Closing the Osteoporosis Care Gap
Authors
Kristina E. Åkesson
Fiona E. A. McGuigan
Publication date
01-02-2021
Publisher
Springer US
Published in
Current Osteoporosis Reports / Issue 1/2021
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-020-00644-w

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