Authors: K M B Huntjens T A C M van Geel M C Blonk J H Hegeman M van der Elst P Willems P P Geusens B Winkens P Brink S H van Helden
Publish Date: 2010/11/04
Volume: 22, Issue: 7, Pages: 2129-2135
Abstract
Implementation of case findings according to guidelines for osteoporosis in fracture patients presenting at a Fracture Liaison Service FLS was evaluated Despite one guideline all FLSs differed in the performance of patient selection and prevalence of clinical risk factors CRFs indicating the need for more concrete and standardised guidelinesFive FLSs were contacted to participate in this prospective study Patients older than 50 years with a recent clinical fracture who were able and were willing to participate in fracture risk evaluation were included Performance was evaluated by criteria for patient recruitment patient characteristics nurse time evaluated clinical risk factors CRFs bone mineral density BMD and laboratory testing and results of CRFs and BMD are presented Differences between FLSs were analysed for performance by chisquare and Student’s t test and for prevalence of CRFs by relative risks RRAll FLSs had a dedicated nurse spending 09 to 17 h per patient During 39 to 58 months followup 7199 patients were evaluated 15 to 47 patients/centre/month mean age 67 years 77 women Major differences were found between FLSs in the performance of patient recruitment evaluation of CRFs BMD and laboratory testing varying between 0 and 100 The prevalence of CRFs and osteoporosis varied significantly between FLSs RR between 17 and 370 depending on the risk factorAll five participating FLSs with a dedicated fracture nurse differed in the performance of patient selection CRFs and in the prevalence of CRFs indicating the need for more concrete and standardised guidelines to organise evaluation of patients at the time of fracture in daily practiceOsteoporotic fractures represent a major growing public health issue The number of fractures in the elderly is expected to increase mainly due to the world’s ageing population 1 Bone mineral density BMD measured by dual energy Xray absorptiometry DXA scan alone is not sufficient to provide an accurate prediction of fracture risk Other clinical nonBMD risk factors are known to be important for estimating an adequate probability of fracture 2 3 A previous fracture doubles the risk for future fractures and vertebral fractures quadruple this risk 4 5 and even more so at shortterm 6 7 8 9 10 Recently the World Health Organization developed a fracture risk assessment FRAX tool to evaluate the 10year fracture risk of patients 11 The FRAX tool integrated clinical risk factors CRFs and BMD to predict the 10year risk of a major osteoporotic and hip fracture but does not include evaluation of fall risksCurrent guidelines on osteoporosis in the Netherlands developed in 2002 recommend that all female patients over 50 years of age with a minimal trauma fracture should be investigated by DXA and treated when having for osteoporosis 12 Moreover women aged 60 years and over with all three known risk factors for fractures a family history of fractures low body weight 67 kg or immobility should be investigated by DXA scan for osteoporosis Women over the age of 70 merely require two of these risk factors 12A fracture liaison service FLS is one of the initiatives in the field of postfracture care to integrate osteoporosis assessment 13 14 15 16 An evaluation of FLSs allowed to identify similarities and differences in the performance of evidencebased medicine and prevalence of CRFs and can be helpful to detect strengths and weaknesses of guideline advices and their implementation The results of previous studies encouraged the start of several FLSs throughout the Netherlands 13 14 15 17 18
Keywords: