Top

Published in:

01-12-2023 | Care | Original Article

Fragility fracture care gap at a tertiary teaching hospital in Malaysia

Authors: Min Hui Cheah, Pauline Siew Mei Lai, Hui Min Khor, Jeyakantha Ratnasingam, C. Sankara Kumar Chandrasekaran, Simmrat Singh, Mohd Idzwan Bin Zakaria, Terence Ong

Published in: Archives of Osteoporosis | Issue 1/2023

Abstract

Summary

Fracture begets fracture, pharmacological treatment is needed to prevent secondary fractures. This study found that there was a fragility fracture care gap where both bone health investigations and treatment initiation rates were low. Strategies such as Fracture Liaison Service is needed to address the care gap.

Purpose

This study aimed to investigate the clinical burden and secondary fracture prevention of fragility fractures at a tertiary teaching hospital in Malaysia.

Methods

Electronic medical records of all patients admitted with fragility fractures between 1 January 2017–31 December 2018 were reviewed. Patients < 50 years old, with non-fragility fractures, restricted access to medical records, transferred to another hospital or who passed away during admission were excluded. Descriptive statistics were used to summarise patients’ characteristics, frequency of fragility fractures, and secondary fracture prevention details. Binomial logistic regression was performed to analyse predictive factors for post-fracture bone health assessments and treatment initiation.

Results

1030 patients [female (767/1030, 74.5%)] presented with 1071 fractures [hip fractures (378/1071, 35.3%)]. 170/993 (17.1%) patients were initiated on anti-osteoporosis medications (AOMs) and 148/984 (15.0%) had bone mineral density (BMD) performed within 1-year post-fracture. Less than half (42.4%) of the patients remained on treatment at 1-year post-fracture. Older patients [65–74 years old: odds ratio (OR) = 2.18, 95%CI 1.05–4.52, p = 0.04; ≥ 75 years: OR = 3.06, 95%CI 1.54–6.07, p < 0.01], hip fractures (OR = 1.95, 95%CI 1.23–3.11, p < 0.01), Chinese ethnicity (OR = 1.90, 95%CI 1.07–3.35, p = 0.03),previously diagnosed with osteoporosis (OR = 2.65, 95%CI:1.32–5.31, p < 0.01) and a BMD test performed (OR = 12.48, 95%CI 8.04–19.37, p < 0.01) were found to have higher AOM initiation. Patients with past diagnosis of osteoporosis (OR = 4.45, 95%CI 2.25–8.81, p < 0.01) and initiated on AOM (OR = 11.34, 95%CI 7.57–16.97, p < 0.01) had a higher likelihood to undergo BMD testing.

Conclusion

The AOM initiation and BMD testing rates were low. There is a need to address the fragility fracture care gap with strategies such as Fracture Liaison Service.

Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12(5):417–427. https://doi.org/10.1007/s001980170112CrossRefPubMed

Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report. Osteoporos Int 4(6):368–381. https://doi.org/10.1007/BF01622200CrossRefPubMed

Cheung C-L, Ang SB, Chadha M, Chow ES-L, Chung Y-S, Hew FL, Jaisamrarn U, Ng H, Takeuchi Y, Wu C-H, Xia W, Yu J, Fujiwara S (2018) An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia 4(1):16–21. https://doi.org/10.1016/j.afos.2018.03.003CrossRefPubMedPubMedCentral

Thiam CN, Khor HM, Pang GHM, Lim WC, Shanmugam T, Chandrasekaran CSK, Singh S, Zakaria MIB, Ong T (2022) Hip fracture management in the emergency department and its impact on hospital outcomes: a retrospective cross-sectional analysis. Eur Geriatr Med. https://doi.org/10.1007/s41999-022-00654-0CrossRefPubMed

Lee J-K, Khir ASM (2007) The incidence of hip fracture in Malaysians above 50 years of age: variation in different ethnic groups. APLAR J Rheumatol 10(4):300–305. https://doi.org/10.1111/j.1479-8077.2007.00314.xCrossRef

Moy F-M, Bulgiba A (2011) High prevalence of vitamin D insufficiency and its association with obesity and metabolic syndrome among Malay adults in Kuala Lumpur, Malaysia. BMC Public Health 11(1):735. https://doi.org/10.1186/1471-2458-11-735CrossRefPubMedPubMedCentral

International Osteoporosis Foundation (2013) The Asia-Pacific Regional Audit: Epidemiology, costs & burden of osteoporosis in 2013. https://www.osteoporosis.foundation/sites/iofbonehealth/files/2019-06/2013_Asia_Pacific_Audit_English.pdf. Accessed 1 Sept 2022

Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2010) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739. https://doi.org/10.1359/jbmr.2000.15.4.721CrossRef

Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: A systematic review. Osteoporos Int 15:767–778. https://doi.org/10.1007/s00198-004-1675-5CrossRefPubMed

10.

Yeap SS, Akhir NSM, Thirunavukkarasu V, Thambiah SC, Samsudin IN, Sham SYZ, Balan P, Hew FL, Chan SP (2018) Osteoporosis treatment following a low trauma wrist fracture presenting to the accident and emergency department from 2011 to 2015 [Review]. Clin Cases Mineral Bone Metab 15(1):74–78. https://doi.org/10.11138/ccmbm/2017.15.1.074CrossRef

11.

Yeap SS, NurFazirah MFR, NurAisyah C, Zahari Sham SY, Samsudin IN, Thambiah SC, Hew FL, Lim BP, Siow YS, Chan SP (2017) Trends in post osteoporotic hip fracture care from 2010 to 2014 in a private hospital in Malaysia. Osteoporos Sarcopenia 3(2):112–116. https://doi.org/10.1016/j.afos.2017.05.001CrossRefPubMedPubMedCentral

12.

Sale JEM, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2011) Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporos Int 22:2067–2082. https://doi.org/10.1007/s00198-011-1544-yCrossRefPubMed

13.

Greenspan SL, Wyman A, Hooven FH, Adami S, Gehlbach S, Anderson FA, Boone S, Lacroix AZ, Lindsay R, Coen Netelenbos J, Pfeilschifter J, Silverman S, Siris ES, Watts NB (2012) Predictors of treatment with osteoporosis medications after recent fragility fractures in a multinational cohort of postmenopausal women. J Am Geriatr Soc 60(3):455–461. https://doi.org/10.1111/j.1532-5415.2011.03854.xCrossRefPubMedPubMedCentral

14.

Sunyecz JA (2008) The use of calcium and vitamin D in the management of osteoporosis. Ther Clin Risk Manag 4(4):827–836. https://doi.org/10.2147/tcrm.s3552CrossRefPubMedPubMedCentral

15.

Kung AW, Fan T, Xu L, Xia WB, Park IH, Kim HS, Chan SP, Lee JK, Koh L, Soong YK, Soontrapa S, Songpatanasilp T, Turajane T, Yates M, Sen S (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(1):7–7. https://doi.org/10.1186/1472-6874-13-7CrossRefPubMedPubMedCentral

16.

Yu YM, Lee JY, Lee E (2017) Access to anti-osteoporosis medication after hip fracture in Korean elderly patients. Maturitas 103:54–59. https://doi.org/10.1016/j.maturitas.2017.06.021CrossRefPubMed

17.

Wang O, Hu Y, Gong S, Xue Q, Deng Z, Wang L, Liu H, Tang H, Guo X, Chen J, Jia X, Xu Y, Lan L, Lei C, Dong H, Yuan G, Fu Q, Wei Y, Xia W, Xu L (2015) A survey of outcomes and management of patients post fragility fractures in China. Osteoporos Int 26(11):2631–2640. https://doi.org/10.1007/s00198-015-3162-6CrossRefPubMed

18.

Tee P, Zamri S, Kasim K, Tiew S (2020) Survey on awareness, knowledge and practices: managing osteoporosis among practitioners in a tertiary hospital, Malaysia. Int J Med Health Sci 164(8):203–213

19.

Mahaisavariya C, Vanitcharoenkul E, Kitcharanant N, Chotiyarnwong P, Unnanuntana A (2023) Exploring the osteoporosis treatment gap after fragility hip fracture at a Tertiary University Medical Center in Thailand. BMC Geriatr 23(1):70. https://doi.org/10.1186/s12877-023-03778-5CrossRefPubMedPubMedCentral

20.

Fleisch H (2001) Can bisphosphonates be given to patients with fractures? J Bone Miner Res 16(3):437–440. https://doi.org/10.1359/jbmr.2001.16.3.437CrossRefPubMed

21.

Gao Y, Liu X, Gu Y, Song D, Ding M, Liao L, Wang J, Ni J, He G (2021) The effect of bisphosphonates on fracture healing time and changes in bone mass density: a meta-analysis. Front Endocrinol (Lausanne) 12:688269. https://doi.org/10.3389/fendo.2021.688269

22.

Chau YT, Nashi N, Law LS-C, Goh RKH, Choo SX, Seetharaman SK (2020) Undertreatment of osteoporosis following hip fracture: a retrospective, observational study in Singapore. Arch Osteoporos 15(1):141. https://doi.org/10.1007/s11657-020-00816-2CrossRefPubMed

23.

Walsh ME, Nerdrum M, Fahey T, Moriarty F (2021) Factors associated with initiation of bone-health medication among older adults in primary care in Ireland. Age Ageing 50(5):1649–1656. https://doi.org/10.1093/ageing/afab033CrossRefPubMedPubMedCentral

24.

Zaris SNABSM, Ahmad MSB, Mohamed SZB, Shuid ANB, Mohamed INB, Mokhtar S (2016) Knowledge and awareness regarding osteoporosis among multi ethnic people attending the orthopaedic clinic at universiti kebangsaan malaysia medical centre. Malaysian J Public Health Med 16:166–175

25.

Posen J, Beaton DE, Sale J, Bogoch ER (2013) Bone mineral density testing after fragility fracture: Informative test results likely. Can Fam Physician 59(12):e564–571

26.

Gregson CL, Armstrong DJ, Bowden J, Cooper C, Edwards J, Gittoes NJL, Harvey N, Kanis J, Leyland S, Low R, McCloskey E, Moss K, Parker J, Paskins Z, Poole K, Reid DM, Stone M, Thomson J, Vine N, Compston J (2022) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 17(1):58. https://doi.org/10.1007/s11657-022-01061-5CrossRefPubMedPubMedCentral

27.

Ministry of Health (2022) Clinical practice guidelines: management of osteoporosis. https://www.osteoporosis.my/GUI/pdf/20220908/2022_CPG-ManagementofOsteoporosis-final.pdf. Accessed 1 Dec 2022

28.

Singer AJ, Liu J, Yan H, Stad RK, Gandra SR, Yehoshua A (2021) Treatment patterns and long-term persistence with osteoporosis therapies in women with Medicare fee-for-service (FFS) coverage. Osteoporos Int 32(12):2473–2484. https://doi.org/10.1007/s00198-021-05951-1CrossRefPubMedPubMedCentral

29.

Ziller V, Kostev K, Kyvernitakis I, Boeckhoff J, Hadji P (2012) Persistence and compliance of medications used in the treatment of osteoporosis–analysis using a large scale, representative, longitudinal German database. Int J Clin Pharmacol Ther 50(5):315–322. https://doi.org/10.5414/cp201632CrossRefPubMed

30.

Morley J, Moayyeri A, Ali L, Taylor A, Feudjo-Tepie M, Hamilton L, Bayly J (2020) Persistence and compliance with osteoporosis therapies among postmenopausal women in the UK Clinical Practice Research Datalink. Osteoporos Int 31(3):533–545. https://doi.org/10.1007/s00198-019-05228-8CrossRefPubMed

31.

Lindsay BR, Olufade T, Bauer J, Babrowicz J, Hahn R (2016) Patient-reported barriers to osteoporosis therapy. Arch Osteoporos 11(1):19. https://doi.org/10.1007/s11657-016-0272-5CrossRefPubMedPubMedCentral

32.

Yood RA, Mazor KM, Andrade SE, Emani S, Chan W, Kahler KH (2008) Patient decision to initiate therapy for osteoporosis: the influence of knowledge and beliefs. J Gen Intern Med 23(11):1815–1821. https://doi.org/10.1007/s11606-008-0772-0CrossRefPubMedPubMedCentral

33.

Yu J, Brenneman SK, Sazonov V, Modi A (2015) Reasons for not initiating osteoporosis therapy among a managed care population. Patient Prefer Adherence 9:821–830. https://doi.org/10.2147/ppa.S81963CrossRefPubMedPubMedCentral

34.

Chami G, Jeys L, Freudmann M, Connor L, Siddiqi M (2006) Are osteoporotic fractures being adequately investigated?: A questionnaire of GP & orthopaedic surgeons. BMC Fam Pract 7(1):1–5. https://doi.org/10.1186/1471-2296-7-7CrossRef

35.

National Pharmaceutical Regulatory Agency (2019) Protaxos® (strontium ranelate): new restricted indication and contraindications for use

36.

Lou S, Lv H, Wang G, Zhang L, Li M, Li Z, Zhang L, Tang P (2016) The effect of teriparatide on fracture healing of osteoporotic patients: a meta-analysis of randomized controlled trials. Biomed Res Int 2016:6040379. https://doi.org/10.1155/2016/6040379CrossRefPubMedPubMedCentral

37.

British Orthopaedic Association (2007) The care of patients with fragility fracture. https://www.bgs.org.uk/resources/care-of-patients-with-fragility-fracture-blue-book. Accessed 1 Sept 2022

38.

Gomez F, Curcio CL, Brennan-Olsen SL, Boersma D, Phu S, Vogrin S, Suriyaarachchi P, Duque G (2019) Effects of the falls and fractures clinic as an integrated multidisciplinary model of care in Australia: a pre-post study. BMJ Open 9(7):e027013. https://doi.org/10.1136/bmjopen-2018-027013CrossRefPubMedPubMedCentral

39.

Åkesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C (2013) Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24(8):2135–2152. https://doi.org/10.1007/s00198-013-2348-zCrossRefPubMedPubMedCentral

40.

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

41.

Yeap SS, Jaisamrarn U, Park Y-S, Takeuchi Y, Xia W, Ang SB et al (2017) The Asian federation of osteoporosis societies’ call to action to improve the undertreatment of osteoporosis in Asia. Osteoporos Sarcopenia 3(4):161–163. https://doi.org/10.1016/j.afos.2017.11.002

42.

Chandran M, Tan MZW, Cheen M, Tan SB, Leong M, Lau TC (2013) Secondary prevention of osteoporotic fractures - An “OPTIMAL” model of care from Singapore. Osteoporos Int 24(11):2809–2817. https://doi.org/10.1007/s00198-013-2368-8CrossRefPubMed

43.

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

Title: Fragility fracture care gap at a tertiary teaching hospital in Malaysia
Authors: Min Hui Cheah
Pauline Siew Mei Lai
Hui Min Khor
Jeyakantha Ratnasingam
C. Sankara Kumar Chandrasekaran
Simmrat Singh
Mohd Idzwan Bin Zakaria
Terence Ong
Publication date: 01-12-2023
Publisher: Springer London
Keywords: 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/s11657-023-01256-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fragility fracture care gap at a tertiary teaching hospital in Malaysia

Abstract

Summary

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

The effect of patient positioning on measurements of bone mineral density of the proximal femur: a simulation study using computed tomographic images

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

An assessment of intervention thresholds for high fracture risk in Chile

First Ecuadorian consensus statement on the management of osteoporosis

Utilization patterns and factors associated with persistence of new users of anti-osteoporosis treatment in Denmark: a population-based cohort study