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The role of the Fracture Liaison Service (FLS) in subsequent fracture prevention in the extreme elderly

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Abstract

Background

Several guidelines recommend a bone and fall-related osteoporosis risk assessment in all patients with fracture and age > 50 years. In practice, however, there is no consensus whether screening > 85 years is useful.

Aim

To evaluate the subsequent fracture risk in all patient > 85 years, comparing the two populations of Fracture Liaison Service (FLS) attenders and non-attenders.

Methods

All patients > 85 years that presented at the FLS with a non-vertebral fracture were included in the study during a 5-year period (September 2004 and December 2009). Excluded were pathologic fractures, death < 30 days, or patients on osteoporosis treatment. in patients that attended the FLS, assessment of bone mineral density and fall-risk factors were screened. In both the attenders and non-attenders groups, mortality and subsequent fracture rates were scored during a follow-up of 2 years.

Results

282 patients fulfilled inclusion criteria for screening, of which 160 (57%) patients did not attend the FLS. 122 patients were screened for osteoporosis and fall-related risk of whom 72 were diagnosed with osteoporosis. Subsequent fracture risk in both groups was 19%. Medical treatment was started in 51 patients, of which 15 patients developed a subsequent fracture. Cox-regression analysis indicated a significantly lower mortality rate, but not a diminished subsequent fracture rate in the FLS screened population compared to the non-attenders.

Conclusion

The advantage of a FLS in reducing subsequent fracture risk in patients > 85 years seems to be limited. In practice a large proportion of these patients are not screened.

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References

  1. Lindsay R, Pack S, Li Z (2005) Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporos Int 16:306–312

    Article  PubMed  Google Scholar 

  2. Melton LJ, Amin S (2013) Is there a specific fracture ‘cascade’? Bonekey Rep 2:367

    Article  PubMed  PubMed Central  Google Scholar 

  3. Johnell O, Kanis JA, Oden A et al (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15:175–179

    Article  CAS  PubMed  Google Scholar 

  4. van Helden S, Cals J, Kessels F et al (2006) Risk of new clinical fractures within 2 years following a fracture. Osteoporos Int 17:348–354

    Article  PubMed  Google Scholar 

  5. Kanis JA, Delmas P, Burckhardt P et al (1997) Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 7:390–406

    Article  CAS  PubMed  Google Scholar 

  6. Kanis JA, Burlet N, Cooper C et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kanis JA, McCloskey EV, Johansson H et al (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57

    Article  CAS  PubMed  Google Scholar 

  8. Eisman JA, Bogoch ER, Dell R et al (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27:2039–2046

    Article  PubMed  Google Scholar 

  9. (2011) Anonymous, Guideline on Osteoporosis and Fracture Prevention. http://www.cbo.nl

  10. Schwartz AV, Nevitt MC, Brown BW Jr et al (2005) Increased falling as a risk factor for fracture among older women: the study of osteoporotic fractures. Am J Epidemiol 161:180–185

    Article  PubMed  Google Scholar 

  11. Sambrook PN, Cameron ID, Chen JS et al (2007) Influence of fall related factors and bone strength on fracture risk in the frail elderly. Osteoporos Int 18:603–610

    Article  CAS  PubMed  Google Scholar 

  12. Melzer I, Benjuya N, Kaplanski J (2004) Postural stability in the elderly: a comparison between fallers and non-fallers. Age Ageing 33:602–607

    Article  CAS  PubMed  Google Scholar 

  13. Center JR, Bliuc D, Nguyen TV et al (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297:387–394

    Article  CAS  PubMed  Google Scholar 

  14. van Helden S, Wyers CE, Dagnelie PC et al (2007) Risk of falling in patients with a recent fracture. BMC Musculoskelet Disord 28:55

    Article  Google Scholar 

  15. Rossiter Fornoff JE, Wolf SL, Wolfson LI et al (1995) A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: cooperative Studies of Intervention techniques. J Gerontol Med Sci 50:M291–M297

    Article  CAS  Google Scholar 

  16. Dodds RM, Syddall HE, Cooper R et al (2014) Grip strength across the life course: normative data from twelve British studies. PLoS One 9::e113637

    Article  CAS  Google Scholar 

  17. Hernlund E, Svedbom A, Ivergard M et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kanis JA, Johnell O (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16:229–238

    Article  CAS  PubMed  Google Scholar 

  19. Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16:3–7

    Article  Google Scholar 

  20. Hui SL, Slemenda CW, Carey MA (1995) Johnston CC jr. choosing between predictors of fractures. J Bone Miner Res 10:1816–1822

    Article  CAS  PubMed  Google Scholar 

  21. Salkeld G, Cameron I, Cumming R et al (2000) Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 320:341–346

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lyles K, Gold D, Shipp K (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601

    Article  CAS  PubMed  Google Scholar 

  23. Fox K, Hawkes W, Hebel J et al (1998) Mobility after hip fracture predicts health outcomes. J Am Geriatr Soc 46:169–173

    Article  CAS  PubMed  Google Scholar 

  24. Crans G, Silverman S, Genant H et al (2004) Association of severe vertebral fractures with reduced quality of life: reduction in the incidence of severe vertebral fractures by teriparatide. Arthritis Rheum 50:4028–4034

    Article  CAS  PubMed  Google Scholar 

  25. Picavet H, Hoeymans N (2004) Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis 63:723–729

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Oleksik AM, Ewing S, Shen W et al (2005) Impact of incident vertebral fractures on health related quality of life (HRQOL) in postmenopausal women with prevalent vertebral fractures. Osteoporos Int 16:861–870

    Article  PubMed  Google Scholar 

  27. Borgstrom F, Lekander I, Ivergard M et al (2013) The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)--quality of life during the first 4 months after fracture. Osteoporos Int 24:811–823

    Article  CAS  PubMed  Google Scholar 

  28. Silverman S, Viswanathan HN, Yang YC et al (2012) Impact of clinical fractures on health-related quality of life is dependent on time of assessment since fracture: results from the FREEDOM trial. Osteoporos Int 23:1361–1369

    Article  CAS  PubMed  Google Scholar 

  29. Lee YK, Lee YJ, Ha YC et al (2014) Five-year relative survival of patients with osteoporotic hip fracture. J Clin Endocrinol Metab 99:97–100

    Article  CAS  PubMed  Google Scholar 

  30. Bliuc D, Nguyen ND, Nguyen TV et al (2013) Compound risk of high mortality following osteoporotic fracture and refracture in elderly women and men. J Bone Miner Res 28:2317–2324

    Article  PubMed  Google Scholar 

  31. Jacobsen SJ, Goldberg J, Miles TP et al (1990) Hip Fracture Incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health 80:871–873

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Hiligsmann M, Rabenda V, Bruyere O et al (2010) The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients. Health Policy 96:170–177

    Article  PubMed  Google Scholar 

  33. Hiligsmann M, Gathon HJ, Bruyère O et al (2010) Cost–effectiveness of osteoporosis screening followed by treatment: the impact of medication adherence. Value Health 13:394–401

    Article  PubMed  Google Scholar 

  34. Solomon DH, Avorn J, Katz JN et al (2005) Compliance With Osteoporosis Medications. Arch Intern Med 165:2414–2419

    Article  PubMed  Google Scholar 

  35. Netelenbos JC, Geusens PP, Ypma G et al (2011) Adherence and profile of non-persistence in patients treated for osteoporosis-a large-scale, long-term retrospective study in the Netherlands. Osteoporosis Int 22:1537–1546

    Article  CAS  Google Scholar 

  36. Boonen S, Dejaeger E, Vanderschueren D et al (2008) Osteoporosis and osteoporotic fracture occurrence and prevention in the elderly: a geriatric perspective. Best Pract Res Clin Endocrinol Metab 22:765–785

    Article  PubMed  Google Scholar 

  37. Inderjeeth CA, Foo AC, Lai MM et al (2009) Efficacy and safety of pharmacological agents in managing osteoporosis in the old old: review of the evidence. Bone 44:744–751

    Article  CAS  PubMed  Google Scholar 

  38. Boonen S, McClung MR, Eastell R et al (2004) Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women age 80 and older: implications for the use of antiresorptive agent in the old and oldest old. J Am Geriatr Soc 52:1832–1839

    Article  PubMed  Google Scholar 

  39. Boonen S, Marin F, Mellstrom D et al (2006) Safety and efficacy of teriparatide in elderly women with established osteoporosis: bone anabolic therapy from a geriatric perspective. J Am Geriatr Soc 54:782–789

    Article  PubMed  Google Scholar 

  40. Reginster JY, Seeman E, De Vernejoul MC et al (2005) Strontium ranelate reduces the risk of non vertebral fracture in post menopausal women with osteoporosis: treatment of peripheral osteoporosis (TROPOS) study. J Clin Endocrinol Metab 90:2816–2822

    Article  CAS  PubMed  Google Scholar 

  41. Meunier PJ, Roux C, Seeman E et al (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Eng J Med 350:459–468

    Article  CAS  Google Scholar 

  42. Rizzoli R, Boonen S, Brandi ML et al (2013) Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Curr Med Res Opin 29:305–313

    Article  CAS  PubMed  Google Scholar 

  43. Van den Bergh JP, Bours SP, van Geel TA et al (2011) Optimal use of vitamin D when treating osteoporosis. Curr Osteoporos Rep 9:36–42

    Article  PubMed  Google Scholar 

  44. Borgstrom F, Jonsson B, Strom O et al (2006) An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials. Osteoporos Int 17:1781–1793

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    Ilknur Sanli & René H. M. ten Broeke

  2. Department of Trauma Surgery, Isala Clinics Zwolle, Zwolle, The Netherlands

    Sven H. van Helden

  3. Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands

    Piet Geusens

  4. Department of Internal Medicine, Viecuri Medical Centre of Noord Limburg, Venlo, The Netherlands

    Joop P. W. Van den Bergh

  5. Department of Trauma Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands

    Peter R. G. Brink & Martijn Poeze

Authors
  1. Ilknur Sanli
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  2. Sven H. van Helden
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  3. René H. M. ten Broeke
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  4. Piet Geusens
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  5. Joop P. W. Van den Bergh
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  6. Peter R. G. Brink
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  7. Martijn Poeze
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Correspondence to Ilknur Sanli.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

The medical ethical committee of the Maastricht University Medical Center has approved the study and the study is conducted according to the revised version of the Declaration of Helsinki (October 2008, Seoul).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Sanli, I., van Helden, S.H., ten Broeke, R.H.M. et al. The role of the Fracture Liaison Service (FLS) in subsequent fracture prevention in the extreme elderly. Aging Clin Exp Res 31, 1105–1111 (2019). https://doi.org/10.1007/s40520-018-1054-2

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  • DOI: https://doi.org/10.1007/s40520-018-1054-2

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