Impact of a fracture liaison service on patient management after an osteoporotic fracture: the CHUV FLS.

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State: Public
Version: author
Serval ID
serval:BIB_79179583CDD7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of a fracture liaison service on patient management after an osteoporotic fracture: the CHUV FLS.
Journal
Swiss medical weekly
Author(s)
Aubry-Rozier B., Stoll D., Gonzalez Rodriguez E., Hans D., Prudent V., Seuret A., Farron A., Lamy O.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Publication state
Published
Issued date
2018
Peer-reviewed
Oui
Volume
148
Pages
w14579
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
In 2008, the Centre Hospitalier Universitaire Vaudois (CHUV, Lausanne, Switzerland) initiated a Fracture Liaison Service (FLS). All patients hospitalised for a low trauma fracture are identified by the FLS. Inpatients then choose to be managed by either the FLS team or their general practitioner (GP). In this study we compared the management between the FLS team and the GP in terms of diagnosis of osteoporosis, treatment, refracture rates and mortality after FLS recording. Results are compared with the management of osteoporosis before the creation of the FLS, as reported in the survey study Osteocare. A total of 606 patients were included (80% women); 55% chose management by the FLS and 45% their GP. The mean age was 78.5, and hip was the main fracture site (44%). The percentage of patients having dual X-ray absorptiometry to diagnose osteoporosis was significantly higher in the FLS group than the GP group (72 vs 26.5%, p <0.01). This percentage was 31.4% in the Osteocare study. Overall, 50.3% of patients in the FLS group had osteoporosis versus 57.5% in the GP group (p <0.05). This percentage was 46.0% in the Osteocare study. Use of osteoporosis medication was higher in the FLS group (FLS 100% of the patients, GP 44.1%, p <0.001) and had increased since the Osteocare study (21.6%). One-year nonvertebral refracture rate was higher in GP group than in the FLS patients (5.1 vs 3.0%, p <0.05), whereas more vertebral fractures were identified in the FLS group, owing to protocol-driven regular clinical and vertebral fracture assessment (VFA) evaluations (number of evaluations 8 vs 0, p <0.01). Unadjusted mortality was higher in GP group than in the FLS group at one and five years (6.93 vs 2.11% and 33.58 vs. 15.96%, p <0.04). After adjustment by age and fracture site, these results were not significant. With FLS management, diagnosis and treatment of osteoporosis were more frequent than with GP management; new nonvertebral fractures were less frequent. Moreover, both forms of management had increased relative to rates reported in a 2004-2006 nationwide survey Osteocare, before FLS creation.
Keywords
Absorptiometry, Photon/methods, Aged, Bone Density Conservation Agents/therapeutic use, Disease Management, Female, Health Services/standards, Hip Fractures/therapy, Humans, Male, Osteoporosis/drug therapy, Osteoporotic Fractures/diagnosis, Osteoporotic Fractures/therapy, Spinal Fractures/therapy, Switzerland
Pubmed
Web of science
Open Access
Yes
Create date
01/02/2018 19:37
Last modification date
03/02/2020 16:16
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