The purpose of this study was to assess the impact of implementation of an outpatient fracture liaison service (FLS) on completion rates of dual-energy x-ray absorptiometry (DXA) and screening labs including 25-OH vitamin D and parathyroid hormone (PTH) in patients with upper extremity (UE) fragility fractures.
Methods:
At our institution, 367 patients were treated in 2014-2015 for UE fragility fractures of the distal radius and proximal humerus before implementation of our outpatient FLS and 395 patients in 2017-2018 after implementation. Retrospective chart review was conducted to identify completed DXA scans within 2 years of fracture treatment and completed 25-OH vitamin D and PTH labs within 1 year of fracture treatment.
Results:
There were no statistical differences in the demographics of patients treated for distal radial and proximal humeral fragility fractures during the 2014-2015 and 2017-2018 time periods. Implementation of the FLS resulted in a 9.9% increase (P value = .021) in completed DXA scans within 2 years of fracture treatment. Completed 25-OH vitamin D and PTH labs saw a significant increase of 17.1% and 23.8%, respectively (P values < .001).
Conclusions:
Implementation of an outpatient FLS can help to improve osteoporosis evaluation with completed DXA scans and 25-OH vitamin D and PTH labs.
CooperCCampionGMeltonLJ.Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285-289. doi:10.1007/BF01623184.
2.
TajeuGSDelzellESmithW, et al. Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci. 2014;69A(3):346-353. doi:10.1093/gerona/glt105.
3.
KanisJAGlüerCC.An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int. 2000;11(3):192-202.
4.
BurgeRDawson-HughesBSolomonDH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22(3):465-475. doi:10.1359/jbmr.061113.
5.
RiggsBLMeltonLJ.The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17(suppl 5):505S-511S. doi:10.1016/8756-3282(95)00258-4.
6.
CosmanFde BeurSJLeBoffMS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-2381. doi:10.1007/s00198-014-2794-2.
GuptaMJShahSPetersonS, et al. Rush Fracture Liaison Service for capturing “missed opportunities” to treat osteoporosis in patients with fragility fractures. Osteoporos Int. 2018;29(8):1861-1874. doi:10.1007/s00198-018-4559-9.
9.
HarperCMFitzpatrickSKZurakowskiD, et al. Distal radial fractures in older men. A missed opportunity?J Bone Joint Surg Am. 2014;96(21):1820-1827. doi:10.2106/JBJS.M.01497.
10.
KimDGSeoGWNamHW.Trends in the diagnosis of osteoporosis in patients with distal radius fractures based on a national claims database. J Bone Metab. 2019;26(4):247-252. doi:10.11005/jbm.2019.26.4.247.
11.
LiuZWeaverJde PappA, et al. Disparities in osteoporosis treatments. Osteoporos Int. 2016;27(2):509-519. doi:10.1007/s00198-015-3249-0.
12.
GiangregorioLPapaioannouACranneyA, et al. Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum. 2006;35(5):293-305. doi:10.1016/j.semarthrit.2005.11.001.
13.
KanisJASvedbomAHarveyN, et al. The osteoporosis treatment gap. J Bone Miner Res. 2014;29(9):1926-1928. doi:10.1002/jbmr.2301.
14.
FreedmanBAPotterBKNestiLJ, et al. Missed opportunities in patients with osteoporosis and distal radius fractures. Clin Orthop Relat Res. 2007;454:202-206. doi:10.1097/01.blo.0000238866.15228.c4.
15.
GongHSOhWSChungMS, et al. Patients with wrist fractures are less likely to be evaluated and managed for osteoporosis. J Bone Joint Surg Am. 2009;91(10):2376-2380. doi:10.2106/JBJS.H.01871.
16.
KimTIChoiJHKimSH, et al. The adequacy of diagnosis and treatment for osteoporosis in patients with proximal humeral fractures. Clin Orthop Surg. 2016;8(3):274-279. doi:10.4055/cios.2016.8.3.274.
17.
WarrinerAHPatkarNMCurtisJR, et al. Which fractures are most attributable to osteoporosis?J Clin Epidemiol. 2011;64(1):46-53. doi:10.1016/j.jclinepi.2010.07.007.
18.
BuntaADEdwardsBJMacaulayWB, et al. Own the Bone, a system-based intervention, improves osteoporosis care after fragility fractures. J Bone Joint Surg Am. 2016;98(24):e109. doi:10.2106/JBJS.15.01494.
19.
MajumdarSRMcAlisterFAJohnsonJA, et al. Comparing strategies targeting osteoporosis to prevent fractures after an upper extremity fracture (C-STOP trial): a randomized controlled trial. J Bone Miner Res. 2018;33(12):2114-2121. doi:10.1002/jbmr.3557.
20.
MoraANBlazarPERogersJC, et al. Patient perceptions and preferences for osteoporosis treatment. J Hand Surg Am. 2020;45(2):153.e1-153.e5. doi:10.1016/j.jhsa.2019.01.018.
21.
ClarkEMGouldVCTobiasJH, et al. Natural history, reasons for, and impact of low/non-adherence to medications for osteoporosis in a cohort of community-dwelling older women already established on medication: a 2-year follow-up study. Osteoporos Int. 2016;27(2):579-590. doi:10.1007/s00198-015-3271-2.
22.
FlaisJCoiffierGLe NoachJ, et al. Low prevalence of osteoporosis treatment in patients with recurrent major osteoporotic fracture. Arch Osteoporos. 2017;12(1):24. doi:10.1007/s11657-017-0317-4.
23.
SolomonDHJohnstonSSBoytsovNN, et al. Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res. 2014;29(9):1929-1937. doi:10.1002/jbmr.2202.
24.
SimonelliCKilleenKMehleS, et al. Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc. 2002;77(4):334-338. doi:10.4065/77.4.334.
25.
FarmerRPHerbertBCuellarDO, et al. Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients’ bone health. Int Orthop. 2014;38(8):1731-1738. doi:10.1007/s00264-014-2317-y.
26.
GehrmannSVWindolfJKaufmannRA.Distal radius fracture management in elderly patients: a literature review. J Hand Surg Am. 2008;33(3):421-429. doi:10.1016/j.jhsa.2007.12.016.
27.
HarnessNGFunahashiTDellR, et al. Distal radius fracture risk reduction with a comprehensive osteoporosis management program. J Hand Surg Am. 2012;37(8):1543-1549. doi:10.1016/j.jhsa.2012.04.033.
28.
ShauverMJClaphamPJChungKC.An economic analysis of outcomes and complications of treating distal radius fractures in the elderly. J Hand Surg Am. 2011;36(12):1912-1918. doi:10.1016/j.jhsa.2011.09.039.
29.
ClintonJFrantaAPolissarNL, et al. Proximal humeral fracture as a risk factor for subsequent hip fractures. J Bone Joint Surg Am. 2009;91(3):503-511. doi:10.2106/JBJS.G.01529.
30.
ChenCWHuangTLSuLT, et al. Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years. J Trauma Acute Care Surg. 2013;74(1):317-321. doi:10.1097/ta.0b013e31824bb325.
