Value of a coordinated management of osteoporosis via Fracture Liaison Service for the treatment of orthogeriatric patients

Eur J Trauma Emerg Surg. 2016 Oct;42(5):559-564. doi: 10.1007/s00068-016-0710-5. Epub 2016 Jul 25.

Abstract

Introduction: The prevalence of osteoporosis in female patients over 75 years of age is 59.2 %. In Germany ~6.3-7.8 million patients are affected by osteoporosis. In 77 % of german patients osteoporosis is not treated adequately. Even after fragility fractures only 16-21 % of female patients and 3 % of male patients are supplied with a specific osteoporosis therapy. Establishing a Fracture Liaison Services (FLS) is a possible addition to co-management for an efficient treatment of osteoporosis in orthogeriatric patients.

Materials and methods: According to a treatment algorithm adapted to the DVO guideline 2014, data of 251 (77 male, 173 female) patients were collected over 3 months. For the assessment specific and standardized questionnaires were used. There was also a basic laboratory testing for osteoporosis done.

Results: The average age of female patients was 76.1 years, in male patients 76.6 years. Thirty-seven patients had vertebral fractures, 25 patients proximal humerus fractures, 18 distal radius fractures and a total of 78 proximal femur fractures were recorded. Eighteen percent of the 251 patients have already been treated with a basic and 11 % with a specific osteoporosis medication. Approximately 40 % of the orthogeriatric patients were diagnosed with osteoporosis for the first time in our clinic. Less than 1 % of the patients had a vitamin D level over 40 ng/ml and 32 % had a vitamin D level under 10 ng/ml. Sixty-five percent of the discharged patients received a basic osteoporosis therapy and 25 % an additional specific therapy.

Discussion: Due to the demographic development osteoporosis-associated fractures steadily increase. In addition to the surgical treatment of fractures, osteological diagnosis and treatment are essential components of successful treatment and critical to the prevention of further fractures. A combination of orthogeriatric center and fracture liaison service allows a more efficient treatment of osteoporosis by close supervision of orthogeriatric patients by the physicians involved.

Keywords: Fracture Liaision Service; Fragility Fracture Nurse; Frailty; Hip fracture; Orthogeriatric patients; Osteoporosis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms
  • Bone Density / drug effects
  • Bone Density Conservation Agents / therapeutic use*
  • Delivery of Health Care / organization & administration*
  • Dietary Supplements
  • Diphosphonates / therapeutic use*
  • Female
  • Germany
  • Humans
  • Male
  • Osteoporosis / complications
  • Osteoporosis / epidemiology
  • Osteoporosis / therapy*
  • Osteoporotic Fractures / prevention & control
  • Patient-Centered Care
  • Practice Guidelines as Topic
  • Secondary Prevention / organization & administration*

Substances

  • Bone Density Conservation Agents
  • Diphosphonates