Characterization and effectiveness of a Fracture Liaison Services program in Colombia

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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.

Supplementary information

The online version contains supplementary material available at 10.1007/s11657-023-01331-w.

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Most cited references 37

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Osteoporosis

Juliet Compston, Michael McClung, William D Leslie (2019)

Fractures resulting from osteoporosis become increasingly common in women after age 55 years and men after age 65 years, resulting in substantial bone-associated morbidities, and increased mortality and health-care costs. Research advances have led to a more accurate assessment of fracture risk and have increased the range of therapeutic options available to prevent fractures. Fracture risk algorithms that combine clinical risk factors and bone mineral density are now widely used in clinical practice to target high-risk individuals for treatment. The discovery of key pathways regulating bone resorption and formation has identified new approaches to treatment with distinctive mechanisms of action. Osteoporosis is a chronic condition and long-term, sometimes lifelong, management is required. In individuals at high risk of fracture, the benefit versus risk profile is likely to be favourable for up to 10 years of treatment with bisphosphonates or denosumab. In people at a very high or imminent risk of fracture, therapy with teriparatide or abaloparatide should be considered; however, since treatment duration with these drugs is restricted to 18-24 months, treatment should be continued with an antiresorptive drug. Individuals at high risk of fractures do not receive adequate treatment and strategies to address this treatment gap-eg, widespread implementation of Fracture Liaison Services and improvement of adherence to therapy-are important challenges for the future.

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World guidelines for falls prevention and management for older adults: a global initiative

Manuel Montero-Odasso, Nathalie van der Velde, Finbarr C Martin … (2022)

Abstract Background falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. Objectives to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. Methods a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. Recommendations all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. Conclusions the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

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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

(2021)

Background Bone fractures are a global public health issue; however, to date, no comprehensive study of their incidence and burden has been done. We aimed to measure the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) of fractures from 1990 to 2019. Methods Using the framework of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we compared numbers and age-standardised rates of global incidence, prevalence, and YLDs of fractures across the 21 GBD regions and 204 countries and territories, by age, sex, and year, from 1990 to 2019. We report estimates with 95% uncertainty intervals (UIs). Findings Globally, in 2019, there were 178 million (95% UI 162–196) new fractures (an increase of 33·4% [30·1–37·0] since 1990), 455 million (428–484) prevalent cases of acute or long-term symptoms of a fracture (an increase of 70·1% [67·5–72·5] since 1990), and 25·8 million (17·8–35·8) YLDs (an increase of 65·3% [62·4–68·0] since 1990). The age-standardised rates of fractures in 2019 were 2296·2 incident cases (2091·1–2529·5) per 100 000 population (a decrease of 9·6% [8·1–11·1] since 1990), 5614·3 prevalent cases (5286·1–5977·5) per 100 000 population (a decrease of 6·7% [5·7–7·6] since 1990), and 319·0 YLDs (220·1–442·5) per 100 000 population (a decrease of 8·4% [7·2–9·5] since 1990). Lower leg fractures of the patella, tibia or fibula, or ankle were the most common and burdensome fracture in 2019, with an age-standardised incidence rate of 419·9 cases (345·8–512·0) per 100 000 population and an age-standardised rate of YLDs of 190·4 (125·0–276·9) per 100 000 population. In 2019, age-specific rates of fracture incidence were highest in the oldest age groups, with, for instance, 15 381·5 incident cases (11 245·3–20 651·9) per 100 000 population in those aged 95 years and older. Interpretation The global age-standardised rates of incidence, prevalence, and YLDs for fractures decreased slightly from 1990 to 2019, but the absolute counts increased substantially. Older people have a particularly high risk of fractures, and more widespread injury-prevention efforts and access to screening and treatment of osteoporosis for older individuals should help to reduce the overall burden. Funding Bill & Melinda Gates Foundation.

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Author and article information

Contributors

Jorge Enrique Machado-Alba:

ORCID: http://orcid.org/0000-0002-8455-0936

machado@utp.edu.co

Journal

Journal ID (nlm-ta): Arch Osteoporos

Journal ID (iso-abbrev): Arch Osteoporos

Title: Archives of Osteoporosis

Publisher: Springer London (London )

ISSN (Print): 1862-3522

ISSN (Electronic): 1862-3514

Publication date (Electronic): 3 October 2023

Publication date PMC-release: 3 October 2023

Publication date (Print): 2023

Volume: 18

Issue: 1

Electronic Location Identifier: 124

Affiliations

[1 ]GRID grid.412256.6, ISNI 0000 0001 2176 1069, Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, , Universidad Tecnológica de Pereira-Audifarma S.A, ; Calle 105 # 14-140, Pereira, Risaralda Colombia

[2 ]Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de Las Américas, ( https://ror.org/04m5pzk31) Pereira, Colombia

[3 ]Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de Las Américas, ( https://ror.org/04m5pzk31) Pereira, Risaralda Colombia

[4 ]GRID grid.7779.e, ISNI 0000 0001 2290 6370, SES Hospital Universitario de Caldas, ; Manizales, Colombia

Author information

Luis Fernando Valladales-Restrepo http://orcid.org/0000-0002-4245-0101

Edgar Eduardo Castro-Osorio http://orcid.org/0000-0003-1921-9881

Andrés Gaviria-Mendoza http://orcid.org/0000-0003-2500-7658

Manuel Enrique Machado-Duque http://orcid.org/0000-0001-8458-0986

Jorge Enrique Machado-Alba http://orcid.org/0000-0002-8455-0936

Article

Publisher ID: 1331

DOI: 10.1007/s11657-023-01331-w

PMC ID: 10547802

PubMed ID: 37789128

SO-VID: bd9b641f-27ae-44dc-8571-30ae322dcc25

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 2 June 2023

Date accepted : 10 September 2023

Funding

Funded by: Technological University of Pereira

Open Access :

Open Access funding provided by Colombia Consortium

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: denosumab,fractures, bone,osteoporosis,falls,preventive health services,teriparatide

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: denosumab, fractures, bone, osteoporosis, falls, preventive health services, teriparatide

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Characterization and effectiveness of a Fracture Liaison Services program in Colombia

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Abstract

Purpose

Methods

Results

Conclusions

Summary

Supplementary information

Related collections

Orthopedics

Most cited references 37

Osteoporosis

World guidelines for falls prevention and management for older adults: a global initiative

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

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