Skip to main content
Top
Published in: Archives of Osteoporosis 1/2020

01-12-2020 | Care | Short Communication

Implementation of a fracture liaison service and its effects on osteoporosis treatment adherence and secondary fracture at a tertiary care academic health system

Authors: Donald J. Scholten II, Jeremy K. Bray, Kevin Y. Wang, Anne F. Lake, Cynthia L. Emory

Published in: Archives of Osteoporosis | Issue 1/2020

Login to get access

Abstract

Summary

In this retrospective study, approximately 77% of patients who attended their osteoporosis clinic follow-up appointments following a fragility fracture were started on medical treatment. Approximately 82% of those patients were adherent with their treatment, and 1% of patients sustained a secondary fragility fracture while on treatment.

Purpose

To assess the effects of implementation of a fracture liaison service at a tertiary care academic medical center on osteoporosis treatment adherence and secondary fracture rates.

Methods

We retrospectively reviewed over 6000 patients age 50 years or greater during a 5-year time period (2013–2018). Patients were identified as having a fragility fracture on presentation to the emergency department at the Wake Forest Baptist Medical Center and referred to our osteoporosis clinic using the electronic medical record. Data were collected regarding those patients who were recommended treatment, started treatment, maintained adherent to treatment, and those who sustained a secondary fracture.

Results

6178 patients were identified as having a fragility fracture and referred to the osteoporosis clinic. 2631 of these patients successfully had a scheduled outpatient appointment at the osteoporosis clinic, of which 1937 attended their initial appointment and 1840 of these patients were prescribed treatment. Of the 1840 patients who were initially prescribed medication, 1416 (76.96%) initiated their treatment, and 1156 (81.64%) remained adherent to treatment. Fifteen patients (1.05%) on treatment sustained a secondary fracture after initiation of therapy.

Conclusion

Implementation of a fracture liaison service at a tertiary care academic medical center is feasible and is associated with high rates of treatment implementation/adherence and low incidence of secondary fracture.
Literature
1.
go back to reference Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B (2014) The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 29:2520–2526CrossRef Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B (2014) The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 29:2520–2526CrossRef
2.
go back to reference Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305CrossRef Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305CrossRef
3.
go back to reference Dirschl DR, Rustom H (2018) Practice patterns and performance in U.S. fracture liaison programs: an analysis of >32,000 patients from the own the bone program. J Bone Joint Surg Am 100:680–685CrossRef Dirschl DR, Rustom H (2018) Practice patterns and performance in U.S. fracture liaison programs: an analysis of >32,000 patients from the own the bone program. J Bone Joint Surg Am 100:680–685CrossRef
4.
go back to reference Giversen IM (2007) Time trends of mortality after first hip fractures. Osteoporos Int 18:721–732CrossRef Giversen IM (2007) Time trends of mortality after first hip fractures. Osteoporos Int 18:721–732CrossRef
5.
go back to reference Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ (2008) Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 39:1157–1163CrossRef Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ (2008) Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 39:1157–1163CrossRef
6.
go back to reference American Orthopaedic A (2005) Leadership in orthopaedics: taking a stand to own the bone. American Orthopaedic Association position paper. J Bone Joint Surg Am 87:1389–1391 American Orthopaedic A (2005) Leadership in orthopaedics: taking a stand to own the bone. American Orthopaedic Association position paper. J Bone Joint Surg Am 87:1389–1391
7.
go back to reference van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629CrossRef van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629CrossRef
8.
go back to reference Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, 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 15:721–739CrossRef Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, 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 15:721–739CrossRef
9.
go back to reference Lewiecki EM, Ortendahl JD, Vanderpuye-Orgle J, Grauer A, Arellano J, Lemay J, Harmon AL, Broder MS, Singer AJ Healthcare policy changes in osteoporosis can improve outcomes and reduce costs in the United States. JBMR Plus 0 Lewiecki EM, Ortendahl JD, Vanderpuye-Orgle J, Grauer A, Arellano J, Lemay J, Harmon AL, Broder MS, Singer AJ Healthcare policy changes in osteoporosis can improve outcomes and reduce costs in the United States. JBMR Plus 0
10.
go back to reference Miller AN, Lake AF, Emory CL (2015) Establishing a fracture liaison service: an orthopaedic approach. J Bone Joint Surg Am 97:675–681CrossRef Miller AN, Lake AF, Emory CL (2015) Establishing a fracture liaison service: an orthopaedic approach. J Bone Joint Surg Am 97:675–681CrossRef
11.
go back to reference Spencer D, Howe G, Manolios N (2012) No more excuses: fracture liaison services work and are cost-effective. Med J Aust 196:384CrossRef Spencer D, Howe G, Manolios N (2012) No more excuses: fracture liaison services work and are cost-effective. Med J Aust 196:384CrossRef
12.
go back to reference Harrington JT, Deal CL (2006) Successes and failures in improving osteoporosis care after fragility fracture: results of a multiple-site clinical improvement project. Arthritis Rheum 55:724–728CrossRef Harrington JT, Deal CL (2006) Successes and failures in improving osteoporosis care after fragility fracture: results of a multiple-site clinical improvement project. Arthritis Rheum 55:724–728CrossRef
13.
go back to reference Jaglal SB, Hawker G, Bansod V, Salbach NM, Zwarenstein M, Carroll J, Brooks D, Cameron C, Bogoch E, Jaakkimainen L, Kreder H (2009) A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada. Osteoporos Int 20:265–274CrossRef Jaglal SB, Hawker G, Bansod V, Salbach NM, Zwarenstein M, Carroll J, Brooks D, Cameron C, Bogoch E, Jaakkimainen L, Kreder H (2009) A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada. Osteoporos Int 20:265–274CrossRef
14.
go back to reference Boudou L, Gerbay B, Chopin F, Ollagnier E, Collet P, Thomas T (2011) Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int 22:2099–2106CrossRef Boudou L, Gerbay B, Chopin F, Ollagnier E, Collet P, Thomas T (2011) Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int 22:2099–2106CrossRef
15.
go back to reference Chakravarthy J, Ali A, Iyengar S, Porter K (2008) Secondary prevention of fragility fractures by orthopaedic teams in the UK: a national survey. Int J Clin Pract 62:382–387CrossRef Chakravarthy J, Ali A, Iyengar S, Porter K (2008) Secondary prevention of fragility fractures by orthopaedic teams in the UK: a national survey. Int J Clin Pract 62:382–387CrossRef
16.
go back to reference Huntjens KM, van Geel TA, Blonk MC, Hegeman JH, van der Elst M, Willems P, Geusens PP, Winkens B, Brink P, van Helden SH (2011) Implementation of osteoporosis guidelines: a survey of five large fracture liaison services in the Netherlands. Osteoporos Int 22:2129–2135CrossRef Huntjens KM, van Geel TA, Blonk MC, Hegeman JH, van der Elst M, Willems P, Geusens PP, Winkens B, Brink P, van Helden SH (2011) Implementation of osteoporosis guidelines: a survey of five large fracture liaison services in the Netherlands. Osteoporos Int 22:2129–2135CrossRef
17.
go back to reference Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057CrossRef Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057CrossRef
18.
go back to reference Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 12:117–127CrossRef Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 12:117–127CrossRef
19.
go back to reference Bliuc D, Nguyen ND, Nguyen TV, Eisman JA, Center JR (2013) Compound risk of high mortality following osteoporotic fracture and refracture in elderly women and men. J Bone Miner Res 28:2317–2324CrossRef Bliuc D, Nguyen ND, Nguyen TV, Eisman JA, Center JR (2013) Compound risk of high mortality following osteoporotic fracture and refracture in elderly women and men. J Bone Miner Res 28:2317–2324CrossRef
Metadata
Title
Implementation of a fracture liaison service and its effects on osteoporosis treatment adherence and secondary fracture at a tertiary care academic health system
Authors
Donald J. Scholten II
Jeremy K. Bray
Kevin Y. Wang
Anne F. Lake
Cynthia L. Emory
Publication date
01-12-2020
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2020
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-020-00736-1

Other articles of this Issue 1/2020

Archives of Osteoporosis 1/2020 Go to the issue