Skip to main content

Advertisement

SpringerLink
Log in

Rationale, study design, and descriptive data of the Lucky Bone™ Fracture Liaison Service

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

The study design of a multidisciplinary Fracture Liaison Service (2-year follow-up) aiming to optimize fragility fracture management in an outpatient setting is presented. Patient characteristics, investigation, and treatment initiation data at baseline were recorded. Results corroborate the care gap in osteoporosis management, reinforcing the need for secondary fracture prevention programs.

Purpose

This paper describes the study design, implementation, and baseline characteristics of a multidisciplinary Fracture Liaison Service (FLS) in Quebec (Canada).

Methods

A FLS was implemented as a prospective cohort study. After identification, fracture risk was assessed and patients were started on treatment or referred, according to guidelines and risk assessment. Thereafter, patients were systematically followed over 2 years. Clinical data (fractures, bone density, blood testing (bone turnover markers), quality of life, physical disability) as well as administrative data (pharmacological, health services, hospitalization) was collected. Baseline descriptive data was analyzed and presented.

Results

Of 542 recruited participants, 532 underwent baseline assessment (85.7% female, mean age 63.4 years). Overall, 29.7% of participants either withdrew from the study or were lost to follow-up. Almost 27% were referred to a specialist, while > 70% received anti-osteoporosis medication prescriptions through the FLS at baseline. Mean femoral T-score was − 1.6 ± 1.0 and vertebral T-score was − 1.7 ± 1.4. Nearly 19% of subjects reported being under anti-osteoporosis medication at the time of incident fracture. Thirty-three percent of participants reported a prior fracture history, of which 29.7% reported being given anti-osteoporosis therapy. Most fracture sites were to the wrist and ankle, while < 19% were hip/femur or vertebral fractures.

Conclusions

These results highlight the important care gap in fragility fracture management and reinforce the need for secondary fracture prevention programs. This prospective study will allow the evaluation of key performance indicators for outpatient clinic-based FLS, such as medication usage, by combining prospective clinical and administrative data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. National Institutes of Health (2001) NIH consensus development panel on osteoporosis prevention, diagnosis, and therapy, March 7-29, 2000: highlights of the conference. South Med J 94:569–573

    Google Scholar 

  2. Ahmed LA, Center JR, Bjornerem A et al (2013) Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Tromso study. J Bone Miner Res 28:2214–2221

    Article  PubMed  Google Scholar 

  3. Pisani P, Renna MD, Conversano F, Casciaro E, di Paola M, Quarta E, Muratore M, Casciaro S (2016) Major osteoporotic fragility fractures: risk factor updates and societal impact. World journal of orthopedics 7:171–181

    Article  PubMed  PubMed Central  Google Scholar 

  4. Maraka S, Kennel KA (2015) Bisphosphonates for the prevention and treatment of osteoporosis. BMJ 351:h3783

    Article  PubMed  Google Scholar 

  5. Sanderson J, Martyn-St James M, Stevens J, Goka E, Wong R, Campbell F, Selby P, Gittoes N, Davis S (2016) Clinical effectiveness of bisphosphonates for the prevention of fragility fractures: a systematic review and network meta-analysis. Bone 89:52–58

    Article  CAS  PubMed  Google Scholar 

  6. Saito T, Sterbenz JM, Malay S, Zhong L, MacEachern MP, Chung KC (2017) Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis. Osteoporos Int 28:3289–3300

    Article  CAS  PubMed  Google Scholar 

  7. Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM (2012) A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving. Osteoporos Int 23:1623–1629

    Article  CAS  PubMed  Google Scholar 

  8. Sattari M, Cauley JA, Garvan C, Johnson KC, LaMonte MJ, Li W, Limacher M, Manini T, Sarto GE, Sullivan SD, Wactawski-Wende J, Beyth RJ (2017) Osteoporosis in the Women’s Health Initiative: another treatment gap? Am J Med 130:937–948

    Article  PubMed  Google Scholar 

  9. Durden E, Pinto L, Lopez-Gonzalez L, Juneau P, Barron R (2017) Two-year persistence and compliance with osteoporosis therapies among postmenopausal women in a commercially insured population in the United States. Arch Osteoporos 12:22

    Article  PubMed  PubMed Central  Google Scholar 

  10. (2014) Institut national d’excellence en santé et en services sociaux (INESSS). Portrait de l’usage des bisphosphonates et du dénosumab chez les personnes de 50 ans ou plus souffrant d’ostéoporose couvertes par le régime public d’assurance médicaments. Portrait d’usage rédigé par Éric Tremblay. Québec, Qc : INESSS2014. p. 99p

  11. Haentjens P, Magaziner J, Colon-Emeric CS et al (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hopkins RB, Burke N, Von Keyserlingk C et al (2016) The current economic burden of illness of osteoporosis in Canada. Osteoporos Int 27:3023–3032. https://doi.org/10.1007/s00198-016-3631-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Akesson K, Marsh D, Mitchell PJ et al (2013) Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Javaid MK, Kyer C, Mitchell PJ et al (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF capture the fracture(R) best practice framework tool. Osteoporos Int 26:2573–2578

    Article  CAS  PubMed  Google Scholar 

  15. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24:393–406

    Article  CAS  PubMed  Google Scholar 

  16. Curtis JR, Silverman SL (2013) Commentary: the five Ws of a fracture liaison service: why, who, what, where, and how? In osteoporosis, we reap what we sow. Curr Osteoporos Rep 11:365–368

    Article  PubMed  Google Scholar 

  17. Nayak S, Greenspan SL (2018) How can we improve osteoporosis care? A systematic review and meta-analysis of the efficacy of quality improvement strategies for osteoporosis. J Bone Miner Res 33:1585–1594. https://doi.org/10.1002/jbmr.3437

    Article  PubMed  Google Scholar 

  18. Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 12:117–127

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ganda K, Schaffer A, Pearson S, Seibel MJ (2014) Compliance and persistence to oral bisphosphonate therapy following initiation within a secondary fracture prevention program: a randomised controlled trial of specialist vs. non-specialist management. Osteoporos Int 25:1345–1355

    Article  CAS  PubMed  Google Scholar 

  20. Beaton DE, Mamdani M, Zheng H, Jaglal S, Cadarette SM, Bogoch ER, Sale JEM, Sujic R, Jain R, Ontario Osteoporosis Strategy Fracture Clinic Screening Program Evaluation Team (2017) Improvements in osteoporosis testing and care are found following the wide scale implementation of the Ontario Fracture Clinic Screening Program: an interrupted time series analysis. Medicine (Baltimore) 96:e9012

    Article  Google Scholar 

  21. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD, for the Scientific Advisory Council of Osteoporosis Canada (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873

    Article  PubMed  PubMed Central  Google Scholar 

  22. Senay A, Delisle J, Raynauld JP, Morin SN, Fernandes JC (2016) Agreement between physicians’ and nurses’ clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone program. Osteoporos Int 27:1569–1576

    Article  CAS  PubMed  Google Scholar 

  23. Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167:S1–S34

    PubMed  PubMed Central  Google Scholar 

  24. Brown JP, Albert C, Nassar BA, Adachi JD, Cole D, Davison KS, Dooley KC, Don-Wauchope A, Douville P, Hanley DA, Jamal SA, Josse R, Kaiser S, Krahn J, Krause R, Kremer R, Lepage R, Letendre E, Morin S, Ooi DS, Papaioaonnou A, Ste-Marie LG (2009) Bone turnover markers in the management of postmenopausal osteoporosis. Clin Biochem 42:929–942

    Article  CAS  PubMed  Google Scholar 

  25. (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. World Health Organ Tech Rep Ser 843:1–129

  26. Lentle B, Cheung AM, Hanley DA, Leslie WD, Lyons D, Papaioannou A, Atkinson S, Brown JP, Feldman S, Hodsman AB, Jamal AS, Josse RG, Kaiser SM, Kvern B, Morin S, Siminoski K, Scientific Advisory Council of Osteoporosis Canada (2011) Osteoporosis Canada 2010 guidelines for the assessment of fracture risk. Can Assoc Radiol J 62:243–250

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M (1998) Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA Project. J Clin Epidemiol 51:1171–1178

    Article  CAS  PubMed  Google Scholar 

  28. Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short Form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken) 63:S240-S252

  29. Gummesson C, Atroshi I, Ekdahl C (2003) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 4:11

    Article  PubMed  PubMed Central  Google Scholar 

  30. Goldhahn S, Kach K, Frei HC et al (2015) Cross-cultural adaptation and validation of the lower extremity measure into German. Geriatr Orthop Surg Rehabil 6:282–288

    Article  PubMed  PubMed Central  Google Scholar 

  31. Haegg O (2013) Oswestry disability index. In: Gebhart GF, Schmidt RF (eds) Encyclopedia of pain. Springer Berlin Heidelberg, Berlin, pp 2559–2562. https://doi.org/10.1007/978-3-642-28753-4_3021

    Chapter  Google Scholar 

  32. Régie de l’assurance maladie du Québec (2017) Rapport annuel de gestion 2016–2017:107–112

    Google Scholar 

  33. Tamblyn R, Reid T, Mayo N, McLeod P, Churchill-Smith M (2000) Using medical services claims to assess injuries in the elderly: sensitivity of diagnostic and procedure codes for injury ascertainment. J Clin Epidemiol 53:183–194

    Article  CAS  PubMed  Google Scholar 

  34. Réseau Québécois de Recherche sur les Médicaments (RQRM). reMed : Data Registry for Prescribed Medications / Banque de données sur les médicaments d'ordonnance.doi. Available from: www.rqrm.ca/plateformes/optimisation-de-l-usage/64-4-remed-data-registry-for-prescribed-medications-banque-de-donnees-sur-les-medicaments-d-ordonnance.html. Accessed 5 June 2018

  35. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  36. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA (2004) New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 57:1288–1294

    Article  PubMed  Google Scholar 

  37. Karlsson L, Lundkvist J, Psachoulia E, Intorcia M, Strom O (2015) Persistence with denosumab and persistence with oral bisphosphonates for the treatment of postmenopausal osteoporosis: a retrospective, observational study, and a meta-analysis. Osteoporos Int 26:2401–2411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Ross AC, Manson JE, Abrams SA et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58

    Article  CAS  PubMed  Google Scholar 

  39. Jean S, Candas B, Belzile E, Morin S, Bessette L, Dodin S, Brown JP (2012) Algorithms can be used to identify fragility fracture cases in physician-claims databases. Osteoporos Int 23:483–501

    Article  CAS  PubMed  Google Scholar 

  40. Kwok OM, Underhill AT, Berry JW, Luo W, Elliott TR, Yoon M (2008) Analyzing longitudinal data with multilevel models: an example with individuals living with lower extremity intra-articular fractures. Rehabil Psychol 53:370–386

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lai D, Xu H, Koller D, Foroud T, Gao S (2016) A multivariate finite mixture latent trajectory model with application to dementia studies. J Appl Stat 43:2503–2523

    Article  PubMed  PubMed Central  Google Scholar 

  42. Ram N, Grimm KJ (2009) Growth mixture modeling: a method for identifying differences in longitudinal change among unobserved groups. Int J Behav Dev 33:565–576

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chandran M, Tan MZ, Cheen M et al (2013) Secondary prevention of osteoporotic fractures--an “OPTIMAL” model of care from Singapore. Osteoporos Int 24:2809–2817

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the participants, orthopedic clinics’ staff, and research assistants involved in this study and Hyukjin Kwon and Courtney Stapleton for their assistance in reviewing this manuscript.

Funding

This study was funded by orthopedic funds from the Hôpital du Sacré-Coeur de Montréal research center in Montreal, Canada, grants from Eli Lilly Canada, the Sanofi Canada Chair of drug usage, and the Réseau Québécois de Recherche sur les Médicaments (RQRM). Senay received a doctoral training award from the Fonds de Recherche du Québec - Santé (FRQS).

Author information

Authors and Affiliations

  1. Faculty of Pharmacy, Université de Montréal, 2900 bl. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada

    Andréa Senay & Sylvie Perreault

  2. CIUSSS Nord de l’Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 bl. Gouin ouest, Montreal, QC, H4J 1C5, Canada

    Andréa Senay, Josée Delisle, Andreea Banica, Yves Troyanov, Pierre Beaumont, Alain Jodoin, G. Yves Laflamme, Stéphane Leduc, Jean-Marc Mac-Thiong, Pierre Ranger, Dominique M. Rouleau & Julio C. Fernandes

  3. Sanofi Aventis endowment Research Chair in Optimal Drug Use, Université de Montréal, Montreal, Canada

    Sylvie Perreault

  4. CIUSSS Nord de l’Ile de Montréal, Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, QC, H2E 1S6, Canada

    Josée Delisle, Andreea Banica, G. Yves Laflamme, Stéphane Leduc, Hai Nguyen, Pierre Ranger & Julio C. Fernandes

  5. McGill University Health Centre, Montreal General Hospital, 1650 Cedar avenue, Room B2.118, Montreal, QC, H3G 1A4, Canada

    Suzanne N. Morin

  6. Institut de rhumatologie de Montréal, 1551 rue Ontario est, Montreal, QC, H2L 1S6, Canada

    Jean-Pierre Raynauld

  7. Faculty of Medicine, Université de Montréal, 2900 bl. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada

    Julio C. Fernandes

  8. Chaire de recherche en orthopédie de l’UdeM au CIUSS NIM, 5400 boul. Gouin ouest, Montreal, QC, H4J 1C5, Canada

    Julio C. Fernandes

Authors
  1. Andréa Senay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sylvie Perreault
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Josée Delisle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suzanne N. Morin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-Pierre Raynauld
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreea Banica
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yves Troyanov
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pierre Beaumont
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alain Jodoin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Yves Laflamme
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Stéphane Leduc
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jean-Marc Mac-Thiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hai Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Pierre Ranger
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Dominique M. Rouleau
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Julio C. Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julio C. Fernandes.

Ethics declarations

All procedures performed in this study involving human participants were in accordance with the ethical standards of the CIUSSS Nord de l’Ile de Montréal ethic research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of interest

Senay, Perreault, Banica, Beaumont, Jodoin, and Nguyen declare that they have no conflict of interest. Delisle reports support for personal fees from Amgen Canada and Eli Lilly outside of the conducted work. Morin reports grants from Amgen Canada and Merck, support as an advisory board member from Amgen Canada and Eli Lilly outside of the conducted work. Raynauld reports fees as an advisory board member for Amgen Canada outside of the conducted work. Troyanov reports fees as an advisory board member for Amgen, Eli Lilly, and Novartis outside of the conducted work. Laflamme reports research grants from Zimmer, Stryker, and DePuy Synthes, and support as a consultant from Stryker outside of the conducted work. Leduc reports research grants from Stryker, DePuy Synthes, Smith & Nephew, and Zimmer, and support as a consultant from Stryker outside of the conducted work. Mac-Thiong reports acts as co-founder of Spinologics Inc. and head of Medtronic Research Chair outside of the conducted work. Ranger reports grants from Johnson & Johnson, support as a consultant from Smith & Nephew, Corin, Bioventus, Sanofi Canada, and support for development of educational presentations by Horizon Pharma outside of the conducted work. Rouleau reports research and educational grants from Zimmer, Stryker, Smith & Nephew, Tornier, Arthrex, Conmed, and DePuy Synthes outside of the conducted work. Fernandes reports grants from Eli Lilly during the conduct of this study and grants from Baxter outside of the conducted work.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 52 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Senay, A., Perreault, S., Delisle, J. et al. Rationale, study design, and descriptive data of the Lucky Bone™ Fracture Liaison Service. Arch Osteoporos 14, 19 (2019). https://doi.org/10.1007/s11657-019-0571-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-019-0571-8

Keywords

Search

Navigation