Top

Published in:

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

Three-year outcomes of a fracture liaison service model at a university-based tertiary care hospital in Thailand

Authors: Pojchong Chotiyarnwong, Nitchanant Kitcharanant, Ekasame Vanitcharoenkul, Chirathit Anusitviwat, Atthakorn Jarusriwanna, Worasit Suthutvoravut, Wararat Boonnasa, Aasis Unnanuntana

Published in: Archives of Osteoporosis | Issue 1/2023

Abstract

Summary

Fragility hip fracture (FHF) is a serious complication of osteoporosis. A fracture liaison service (FLS) is crucial in preventing FHF. Our retrospective data of 489 patients with FHF and 3-year follow-ups demonstrated that the FLS improved functional outcomes. Our study’s mortality rates were lower than in other published series.

Purpose

This study assessed the 3-year outcomes after fragility hip fracture (FHF) treatment by a multidisciplinary team from the Siriraj Fracture Liaison Service (Si–FLS). The review investigated the administration rates of anti-osteoporosis medication, refracture, and mortality; activities of daily living; mobility; and health-related quality of life.

Methods

A retrospective review was performed of the records of Si-FLS patients given FHF treatment between June 2016 and October 2018. The outcomes were evaluated at 3 time points: before discharge, and 1 and 3 years after treatment.

Results

The study enrolled 489 patients (average age, 78). The mortality and refracture rates at 1 year after hip fracture were 13.9% and 1.6%, respectively. At the 3-year follow-up, both rates were higher (20.4% and 5.7%, respectively). The Barthel Index and EuroQoL Visual Analogue Scale had risen to a plateau at the 1-year follow-up and remained stable to the 3-year follow-up. One year after treatment, approximately 60% of the patients could ambulate outdoors, and the proportion remained steady until the 3-year follow-up. There was no difference in the 1- and 3-year follow-up anti-osteoporosis medication administration rates (approximately 40%).

Conclusions

This study confirms the benefits of having a multidisciplinary FLS care team to manage older people with FHF. An FLS improves the care of patients with FHF and the social support of caregivers and relatives. The FLS maintained the functional outcomes of the patients through 3 years of postfracture treatment.

Chapurlat RD, Bauer DC, Nevitt M, Stone K, Cummings SR (2003) Incidence and risk factors for a second hip fracture in elderly women. The Study of Osteoporotic Fractures. Osteoporos Int 14:130–136. https://doi.org/10.1007/s00198-002-1327-6CrossRefPubMed

Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882. https://doi.org/10.1016/S0140-6736(98)09075-8CrossRefPubMed

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 24:393–406. https://doi.org/10.1007/s00198-012-2090-yCrossRefPubMed

Kung AW, Fan T, Xu L et al (2013) Factors influencing diagnosis and treatment of osteoporosis after a fragility fracture among postmenopausal women in Asian countries: a retrospective study. BMC Womens Health 13:7. https://doi.org/10.1186/1472-6874-13-7CrossRefPubMedPubMedCentral

Tosi LL, Gliklich R, Kannan K, Koval KJ (2008) The American Orthopaedic Association’s “own the bone” initiative to prevent secondary fractures. J Bone Joint Surg Am 90:163–173. https://doi.org/10.2106/JBJS.G.00682CrossRefPubMed

Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C, Group IOFFW (2013) Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152. https://doi.org/10.1007/s00198-013-2348-zCrossRef

Siris ES, Bilezikian JP, Rubin MR, Black DM, Bockman RS, Bone HG, Hochberg MC, McClung MR, Schnitzer TJ (2003) Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab 88:3482–3486. https://doi.org/10.1210/jc.2003-030568CrossRefPubMed

Chang Y, Huang C, Hwang J, Kuo J, Lin K, Huang H, Bagga S, Kumar A, Chen F, Wu C (2018) Fracture liaison services for osteoporosis in the Asia-Pacific region: current unmet needs and systematic literature review. Osteoporos Int 29:779–792. https://doi.org/10.1007/s00198-017-4347-yCrossRefPubMed

Anusitviwat C, Vanitcharoenkul E, Chotiyarnwong P, Unnanuntana A (2022) Surgical treatment for fragility hip fractures during the COVID-19 pandemic resulted in lower short-term postoperative functional outcome and a higher complication rate compared to the pre-pandemic period. Osteoporos Int. https://doi.org/10.1007/s00198-022-06485-wCrossRefPubMedPubMedCentral

10.

Unnanuntana A, Chotiyarnwong P (2017) The use of stratified vitamin D2 supplementation regimen for restoring and maintaining sufficient vitamin D level. J Med Assoc Thailand 100:1095–1103

11.

Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E (2009) FRAX and its applications to clinical practice. Bone 44:734–743. https://doi.org/10.1016/j.bone.2009.01.373CrossRefPubMed

12.

Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65PubMed

13.

Unnanuntana A, Jarusriwanna A, Nepal S (2018) Validity and responsiveness of Barthel index for measuring functional recovery after hemiarthroplasty for femoral neck fracture. Arch Orthop Trauma Surg 138:1671–1677. https://doi.org/10.1007/s00402-018-3020-zCrossRefPubMed

14.

Tidermark J, Zethraeus N, Svensson O, Tornkvist H, Ponzer S (2002) Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma 16:34–38. https://doi.org/10.1097/00005131-200201000-00008CrossRefPubMed

15.

Chandran M, Lau TC, Gagnon-Arpin I, Dobrescu A, Li W, Leung MYM, Patil N, Zhao Z (2019) The health and economic burden of osteoporotic fractures in Singapore and the potential impact of increasing treatment rates through more pharmacological options. Arch Osteoporos 14:114. https://doi.org/10.1007/s11657-019-0664-4CrossRefPubMed

16.

Lau EM, Lee JK, Suriwongpaisal P, Saw SM, De Das S, Khir A, Sambrook P (2001) The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12:239–243. https://doi.org/10.1007/s001980170135CrossRefPubMed

17.

Marsh D, Akesson K, Beaton DE et al (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22:2051–2065. https://doi.org/10.1007/s00198-011-1642-xCrossRefPubMed

18.

Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK. Available at https://www.sheffield.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf. Accessed 19 April 2022

19.

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

20.

Kittithamvongs P, Pongpirul K (2019) Prescription practices of anti-osteoporosis medication among Thai orthopedic surgeons (PAMOS study) in osteoporotic hip fracture. Arch Osteoporos 14:62. https://doi.org/10.1007/s11657-019-0616-zCrossRefPubMed

21.

Tay CL, Ng WL, Beh HC, Lim WC, Hussin N (2022) Screening and management of osteoporosis: a survey of knowledge, attitude and practice among primary care physicians in Malaysia. Arch Osteoporos 17:72. https://doi.org/10.1007/s11657-022-01111-yCrossRefPubMedPubMedCentral

22.

Chiang MH, Huang YY, Kuo YJ, Huang SW, Jang YC, Chu FL,Chen YP (2022) Prognostic factors for mortality, activity of daily living, and quality of life in Taiwanese older patients within 1 year following hip fracture surgery. J Pers Med 12:102. https://doi.org/10.3390/jpm12010102

23.

Imai N, Endo N, Suda K, Suzuki H (2021) Multidisciplinary approach to reduce postoperative complications and improve the activity of patients with hip fracture: a 24-month follow-up survey. Acta Med Okayama 75:595–600. https://doi.org/10.18926/AMO/62772CrossRefPubMed

24.

Svedbom A, Borgstrom F, Hernlund E et al (2018) Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-off: results from the ICUROS. Qual Life Res 27:707–716. https://doi.org/10.1007/s11136-017-1748-5CrossRefPubMed

25.

van der Vet PCR, Kusen JQ, Rohner-Spengler M, Link BC, Verleisdonk EMM, Knobe M, Henzen C, Schmid L, Babst R, Beeres FJP (2021) The quality of life, patient satisfaction and rehabilitation in patients with a low energy fracture-part III of an observational study. Geriatr Orthop Surg Rehabil 12:21514593211046410. https://doi.org/10.1177/21514593211046407CrossRefPubMedPubMedCentral

26.

Vaseenon T, Luevitoonvechkij S, Wongtriratanachai P, Rojanasthien S (2010) Long-term mortality after osteoporotic hip fracture in Chiang Mai, Thailand. J Clin Densitom 13:63–67. https://doi.org/10.1016/j.jocd.2009.10.003CrossRefPubMed

27.

Huang CM, Su CY, Chien LY, Guo JL (2011) The effectiveness of an osteoporosis prevention program among women in Taiwan. Appl Nurs Res 24:e29-37. https://doi.org/10.1016/j.apnr.2010.02.006CrossRefPubMed

28.

Inderjeeth CA, Glennon DA, Poland KE, Ingram KV, Prince RL, Van VR, Holman CD (2010) A multimodal intervention to improve fragility fracture management in patients presenting to emergency departments. Med J Aust 193:149–153. https://doi.org/10.5694/j.1326-5377.2010.tb03958.xCrossRefPubMed

29.

Rojanasthien S, Chiewchantanakit S, Vaseenon T (2005) Diagnosis and treatment of osteoporosis following hip fracture in Chiang Mai University Hospital. J Med Assoc Thai 88(Suppl 5):S65-71PubMed

Title: Three-year outcomes of a fracture liaison service model at a university-based tertiary care hospital in Thailand
Authors: Pojchong Chotiyarnwong
Nitchanant Kitcharanant
Ekasame Vanitcharoenkul
Chirathit Anusitviwat
Atthakorn Jarusriwanna
Worasit Suthutvoravut
Wararat Boonnasa
Aasis Unnanuntana
Publication date: 01-12-2023
Publisher: Springer London
Keywords: Refracture
Care
Osteoporosis
Osteoporosis
Published in: Archives of Osteoporosis / Issue 1/2023
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-023-01215-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Three-year outcomes of a fracture liaison service model at a university-based tertiary care hospital in Thailand

Abstract

Summary

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Occipital bone and tumor-induced osteomalacia: a rare tumor site for an uncommon paraneoplastic syndrome

Prevalence of glucocorticoid-induced osteoporosis among rheumatology patients in Africa: a systematic review and meta-analysis

A new FRAX model for Brazil

A clinical prediction model for 10-year risk of self-reported osteoporosis diagnosis in pre- and perimenopausal women

Frequency of osteoporosis in Chinese patients with rheumatoid arthritis: a meta-analysis

A new digital case-based educational program Orthogeriatrics TeleECHO, a strategy to improve the care of fragility fracture patients