Advertisement

The Falls and Fractures Clinic – An Integrated Model of Care for Osteosarcopenic Patients

  • Fernando GomezEmail author
  • Carmen-Lucia Curcio
Chapter

Abstract

Osteosarcopenia is a newly described syndrome that features the coexistence of osteoporosis and sarcopenia, two chronic musculoskeletal conditions associated with aging. Researchers estimate that between 10% and 40% of community-dwelling individuals over the age of 65 years have osteosarcopenia. Several studies have confirmed that sarcopenia and osteoporosis share common risk factors and biological pathways. The consequences of osteosarcopenia include higher risk of falls, fractures, hospitalization, disability, poorer quality of life, increased morbidity, institutionalization, and death. High-risk osteosarcopenic patients and their outcomes should be clearly identified and treated to avoid the catastrophic consequences of the “hazardous duet” of falls due to sarcopenia and fractures due to osteoporosis, which results in high healthcare costs. Several models of care have been established for management and treatment of outcomes of osteosarcopenia. However, no model of care for patients with osteosarcopenia has been proposed thus far. By increasing our understanding of the bone-muscle unit, effective therapeutic interventions could be offered for patients with osteosarcopenia. This chapter discusses several models of care for outcomes of osteosarcopenia, including falls clinics, orthogeriatric models of care for low-trauma fragility fractures, and fracture liaison services for evaluation and management of patients with osteoporotic fractures. Finally, a specific model of care for osteosarcopenic patients is discussed, and some aspects related to organization, administration, client characteristics, and interventions based on the literature are described. Furthermore, a process flow diagram for a falls and fractures clinic is proposed. Based on the comprehensive geriatric assessment (CGA), the most important aspects in the evaluation of osteosarcopenic patients are described, and remarks are given on key concepts of their management in a falls and fractures clinic.

Keywords

Osteosarcopenia Osteoporosis Sarcopenia Muscle Bone Falls Fractures Older persons Aging Blood tests Assessment Nutrition Cognition Mobility Function Guidelines Clinical pathways Interventions Osteoporosis treatment Bisphosphonates Denosumab Teriparatide Bone anabolics Anti-myostatin antibody 

References

  1. ACI (2019) Orthogeriatric model of care: Clinical practice guide 2010. Available at http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0013/153400/aci_orthogeriatrics_clinical_practice_guide.pdf. Accessed January 19, 2019
  2. Aizer J, Bolster MB (2014) Fracture liaison services: promoting enhanced bone health care. Curr Rheumatol Rep 16(11):455PubMedCrossRefGoogle Scholar
  3. Ambrose AF, Cruz L, Paul G (2015) Falls and fractures: a systematic approach to screening and prevention. Maturitas 82(1):85–93PubMedCrossRefPubMedCentralGoogle Scholar
  4. Antonelli-Incalzi R, Gemma A, Capparella O (2008) Orthogeriatric unit: a thinking process and a working model. Aging Clin Exp Res 20(2):109–112PubMedCrossRefPubMedCentralGoogle Scholar
  5. BC Guidelines Osteoporosis (2019) Diagnosis, treatment and fracture prevention developed by the guidelines and protocols Advisory Committee on behalf of the Medical Services Commission. Available from: http://www2gov.bc.ca/gov/topic.page?id=F8231A43423D4AF5B173EECE777FA911#Step. Accessed 19 Jan 2019
  6. Blain H, Masud T, Dargent-Molina P, Martin FC, Rosendalh E, van der Velde N et al (2016) A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) Statement. J Nutr Health Aging 20:647–652PubMedPubMedCentralCrossRefGoogle Scholar
  7. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention (2019). Available from: http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/index.html. Accessed 19 Jan 2019
  8. Chang JT, Ganz DA (2007) Quality indicators for falls and mobility problems in vulnerable elders. J Am Geriatr Soc 55(Suppl 2):S327–S334PubMedCrossRefPubMedCentralGoogle Scholar
  9. Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C (1999) Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 353:93–97PubMedCrossRefPubMedCentralGoogle Scholar
  10. Crepaldi G, Maggi S (2015) Sarcopenia and osteoporosis: a hazardous duet. J Endocrinol Investig 28(Suppl 10):66–68Google Scholar
  11. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48(1):16–31PubMedPubMedCentralCrossRefGoogle Scholar
  12. Daly RM (2017) Exercise and nutritional approaches to prevent frail bones, falls and fractures: an update. Climacteric 20:119–124PubMedCrossRefPubMedCentralGoogle Scholar
  13. De Rui M, Inelmen EM, Pigozzo S, Trevisan C, Manzato E, Sergi G (2019) Dietary strategies for mitigating osteosarcopenia in older adults: a narrative review. Aging Clin Exp Res 31:897–903.  https://doi.org/10.1007/s40520-019-01130-9CrossRefPubMedPubMedCentralGoogle Scholar
  14. Demontiero O, Boersma D, Suriyaarachchi P, Duque G (2014) Clinical outcomes of impaired muscle and bone interactions. Clinic Rev Bone Miner Metab 12(2):86–92CrossRefGoogle Scholar
  15. Department of Health (2009) Falls and fractures, effective interventions in health and social care. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_103146. Accessed 16 Jan 2019
  16. Drey M, Sieber CC, Bertsch T, Bauer JM, Schmidmaier R (2016) FIAT intervention group. Osteosarcopenia is more than sarcopenia and osteopenia alone. Aging Clin Exp Res 28(5):895–899PubMedPubMedCentralCrossRefGoogle Scholar
  17. Eckstrom E, Neal MB, Cotrell V, Casey CM, Mckenzie G, Morgove M et al (2016) An interprofessional approach to reducing the risk of falls through enhanced collaborative practice. J Am Geriatr Soc 64(8):1701–1707PubMedPubMedCentralCrossRefGoogle Scholar
  18. Feder G, Cryer C, Donovan S, Carter Y (2000) Guidelines for the prevention of falls in people over 65. BMJ 321(7267):1007–1011PubMedPubMedCentralCrossRefGoogle Scholar
  19. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198Google Scholar
  20. Friedman SM, Mendelson DA, Bingham KW, Kates SL (2009) Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med 169(12):1712–1717PubMedCrossRefPubMedCentralGoogle Scholar
  21. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR et al (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24(2):393–406PubMedCrossRefPubMedCentralGoogle Scholar
  22. Giusti A, Barone A, Razzano M, Pizzonia M, Pioli G (2011) Optimal setting and care organization in the management of older adults with hip fracture. Eur J Phys Rehabil Med 47(2):281–296PubMedPubMedCentralGoogle Scholar
  23. Gomez F, Curcio CL, Suriyaarachchi P, Demontiero O, Duque G (2013a) Differing approaches to falls and fracture prevention between Australia and Colombia. Clin Interv Aging 8:61–67PubMedPubMedCentralGoogle Scholar
  24. Gomez F, Curcio C-L, Alvarado B, Zunzunegui MV, Guralnik J (2013b) Validity and reliability of the Short Physical Performance Battery (SPPB): a pilot study on mobility in the Colombian Andes. Colombia Medica 44:165–171PubMedPubMedCentralGoogle Scholar
  25. Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL, Thompson JH (2018a) Interventions to prevent falls in community-dwelling older adults: a systematic review for the U.S. preventive services task force. Evidence synthesis no. 159. AHRQ Publication No. 17-05232- EF-1. Rockville, Agency for Healthcare Research and QualityGoogle Scholar
  26. Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL (2018b) Interventions to prevent falls in older adults. Updated evidence reports and systematic review for the US preventive services task force. JAMA 319:1705–1716PubMedCrossRefPubMedCentralGoogle Scholar
  27. Hassan EB, Duque G (2017) Osteosarcopenia: a new geriatric syndrome. Aust Fam Physician 46(11):849–853PubMedPubMedCentralGoogle Scholar
  28. Hawley S, Javaid MK, Prieto-Alhambra D, Lippet J, Sheard S, Arden NK et al (2016) REFReSH study group. Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study. Age Ageing 45(2):236–242PubMedPubMedCentralCrossRefGoogle Scholar
  29. Hill K, Smith R, Schwarz J (2001) Falls clinics in Australia: a survey of current practice, and recommendations for future development. Aust Health Rev 24(4):163–174PubMedCrossRefPubMedCentralGoogle Scholar
  30. Hill KD, Moore KJ, Dorevitch MI, Day LM (2008) Effectiveness of falls clinics: an evaluation of outcomes and client adherence to recommended interventions. J Am Geriatr Soc 56(4):600–608PubMedCrossRefGoogle Scholar
  31. Hirschfeld HP, Kinsella R, Duque G (2017) Osteosarcopenia: where bone, muscle, and fat collide. Osteoporos Int 28:2781–2790CrossRefGoogle Scholar
  32. Ho WW, Kwan Dai DL, Liu KW, Chow KM, Lau E, Woo J, Leung KS (2009) To investigate the effect and cost-effectiveness of implementing an orthogeriatrics intervention for elderly patients with acute hip fracture: the experience in Hong Kong. J Am Geriatr Soc 57(11):2153–2154PubMedCrossRefGoogle Scholar
  33. Hopewell S, Adedire O, Copsey BJ, Boniface GJ, Sherrington C, Clemson L, Close JCT, Lamb SE (2018) Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Datab Syst Rev Issue 7:Art. No.: CD012221Google Scholar
  34. Huo YR, Suriyaarachchi P, Gomez F, Curcio CL, Boersma D, Muir S et al (2015) Phenotype of osteosarcopenia in older individuals with a history of falling. J Am Med Dir Assoc 16(4):290–295CrossRefGoogle Scholar
  35. Jiang S, Li P (2016) Current development in elderly comprehensive assessment and research methods. Biomed Res Int 2016:10Google Scholar
  36. Johnson K, Suriyaarachchi P, Kakkat M, Boersma D, Gunawardene P, Demontiero O et al (2015) Yield and cost-effectiveness of laboratory testing to identify metabolic contributors to falls and fractures in older persons. Arch Osteoporos 10:226PubMedCrossRefPubMedCentralGoogle Scholar
  37. Kammerlander C, Roth T, Friedman SM et al (2010) Ortho-geriatric service–a literature review comparing different models. Osteoporos Int 21:S637–S646PubMedCrossRefPubMedCentralGoogle Scholar
  38. Kanis JA, Adachi JD, Cooper C, Clark P, Cummings SR, Diaz-Curiel M, The Epidemiology and Quality of Life Working Group of IOF et al (2013) Standardising the descriptive epidemiology of osteoporosis: recommendations from the Epidemiology and Quality of Life Working Group of IOF. Osteoporos Int 24(11):2763–2764PubMedPubMedCentralCrossRefGoogle Scholar
  39. Kull M, Kallikorm R, Lember M (2012) Impact of a new sarco-osteopenia definition on health-related quality of life in a population based cohort in Northern Europe. J Clin Densitom 15(1):32–38PubMedCrossRefGoogle Scholar
  40. Martinez-Reig M, Ahmad L, Duque G (2012) The orthogeriatrics model of care: systematic review of predictors of institutionalization and mortality in post-hip fracture patients and evidence for interventions. J Am Med Dir Assoc 13:770–777PubMedCrossRefPubMedCentralGoogle Scholar
  41. McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003) The FLS: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14(12):1028–1034PubMedCrossRefPubMedCentralGoogle Scholar
  42. Melton LJ, Thamer M, Ray NF et al (1997) Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 12(1):16–23PubMedCrossRefPubMedCentralGoogle Scholar
  43. Miller AN, Lake AF, Emory CL (2015) Establishing a fracture liaison service: an orthopaedic approach. J Bone Joint Surg Am 97(8):675–681PubMedCrossRefPubMedCentralGoogle Scholar
  44. Paintin J, Cooper C, Dennison E (2018) Osteosarcopenia. Br J Hosp Med (Lond) 79(5):253–258CrossRefGoogle Scholar
  45. Palvanen M, Kannus P, Piirtola M, Niemi S, Parkkari J, Järvinen M (2014) Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: a randomised controlled trial. Injury 45(1):265–271PubMedCrossRefPubMedCentralGoogle Scholar
  46. Pasco JA, Mohebbi M, Holloway KL, Brennan-Olsen SL, Hyde NK, Kotowicz MA (2017) Musculoskeletal decline and mortality: prospective data from the Geelong osteoporosis study. J Cachexia Sarcopenia Muscle 8(3):482–489PubMedCrossRefPubMedCentralGoogle Scholar
  47. Providence Health Care (2008) Outpatient services: falls and fracture prevention clinic. Available from: http://www.providencehealthcare.org/info_outpatient_ff_prevention.html. Accessed 18 Jan 2019
  48. Schoon Y, Hoogsteen-Ossewaarde ME, Scheffer AC, Van Rooij FJ, Rikkert MG, De Rooij SE (2011) Comparison of different strategies of referral to a fall clinic: how to achieve an optimal casemix? J Nutr Health Aging 15(2):140–145PubMedCrossRefPubMedCentralGoogle Scholar
  49. Scott D, Chandrasekara SD, Laslett LL, Cicuttini F, Ebeling PR, Jones G (2016) Associations of sarcopenic obesity and dynapenic obesity with bone mineral density and incident fractures over 5–10 years in community-dwelling older adults. Calcif Tissue Int 99(1):30–42PubMedPubMedCentralCrossRefGoogle Scholar
  50. Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, Yang CT (2005) A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc 53(5):811–818PubMedCrossRefPubMedCentralGoogle Scholar
  51. Singh S, Kwon A, Whitehurst DGT, Friesen K, Scott V, Hejazi S et al (2018) Fall prevention Mobile clinic: a novel fall prevention program for community-dwelling older adults. Can J Aging 37(4):482–495PubMedCrossRefPubMedCentralGoogle Scholar
  52. Sze PC, Cheung WH, Lam PS, Lo HS, Leung KS, Chan T (2008) The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program. Arch Phys Med Rehabil 89(7):1329–1334PubMedCrossRefPubMedCentralGoogle Scholar
  53. Tran HT, Leonard SD (2017) Geriatric assessment for primary care providers. Prim Care 44(3):399–411PubMedCrossRefPubMedCentralGoogle Scholar
  54. Van der Kallen J, Giles M, Cooper K, Gill K, Parker V, Tembo A et al (2014) A fracture prevention service reduces further fractures two years after incident minimal trauma fracture. Int J Rheum Dis 17(2):195–203PubMedCrossRefPubMedCentralGoogle Scholar
  55. Vidán M, Serra JA, Moreno C, Riquelme G, Ortiz J (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53(9):1476–1482PubMedCrossRefPubMedCentralGoogle Scholar
  56. Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 12:117–121PubMedPubMedCentralCrossRefGoogle Scholar
  57. Wang YJ, Wang Y, Zhan JK, Tang ZY, He JY, Tan P et al (2015) Sarco-osteoporosis: prevalence and association with frailty in Chinese community-dwelling older adults. Int J Endocrinol 2015:482940PubMedPubMedCentralGoogle Scholar
  58. Woo J (2017) Sarcopenia. Clin Geriatr Med 33(3):305–314PubMedCrossRefGoogle Scholar
  59. Wu CH, Chen CH, Chen PH, Yang JJ, Chang PC, Huang TC et al (2018) Identifying characteristics of an effective fracture liaison service: systematic literature review. Osteoporos Int 29(5):1023–1047PubMedCrossRefPubMedCentralGoogle Scholar
  60. Zanker J, Duque G (2018) Osteoporosis in older persons: old and new players. J Am Geriatr Soc 67:831–840.  https://doi.org/10.1111/jgs.15716CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Research Group on Geriatrics and Gerontology, Faculty of Health SciencesUniversidad de CaldasManizalesColombia

Personalised recommendations