After the first fragility fracture, there is a high risk of subsequent fractures, with the risk highest in the following two years. Despite the enormous human and cost burden of secondary fractures, bone health experts warn that too little is being done to systematically identify and treat high risk patients who are in danger of sustaining such fractures, including highly debilitating and life-threatening hip fractures.
As in previous years, secondary fracture prevention, and specifically topics related to Post-fracture Care Coordination Program (such as Fracture Liaison Service - FLS) development, are a focus of several live and pre-recorded presentations at the virtual World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2020 from August 20-22, 2020. The Congress is the largest event in the field, organized annually by the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).
IOF President and Congress Co-Chair, Professor Cyrus Cooper, noted:
"Implementation of effective post-fracture care coordination programmes worldwide is a key focus of the global healthcare community's efforts to reduce secondary osteoporosis-related fractures, frailty and mortality in older patients. It is therefore heartening to see that this is a key topic addressed at the World Congress."
Among the research presented is an abstract (OCS8) and oral presentation by R. Pineda-Villanueva (University of Oxford, NDORMS) which introduces a novel FLS benefits and budget impact calculator [1]. The interactive tool models the expected clinical and healthcare resource use and cost savings impact of Post-Fracture Care services such as FLS and is expected to support decision-making at national and local levels. The model is currently undergoing input parameter population and calibration for Spain and Japan, and is expected to be operational for 16 countries by 2022.
A Canadian study (OC36) presented by J. Delisle (CIUSSS Nord de L'Ile de Montreal, Montreal, Canada) assesses the success of the Lucky BoneTM FLS in the management of hip fractures based on initiation/continuation of anti-osteoporosis treatment (Osteoporosis Canada Guidelines). The study finds that the combined treatment initiation or continuation rate of the hip fracture patients in the studied FLS was 71.4%. In contrast, most FLS identifying hip fractures report an approximate 46% treatment initiation rate. It also finds that the ca. 30% of patients that were not initiated on treatment were the most at-risk for a subsequent fracture.
The drive to implement systems of secondary fracture prevention is addressed from a policy perspective in a non-sponsored symposium 'Winning the political case for change - launch of a policy toolkit for osteoporosis and fragility fractures' [3]. A further symposium 'Nationwide identification of vertebral fragility fractures: Collaborating with Radiology' pointed to the need for collaboration to improve patient outcomes, and the benefits of and future directions in the identification of vertebral fractures within post-fracture care coordination programs such as FLS [4].
In June 2020 the IOF launched its Capture the Fracture (CTF) Partnership which aims to support wider implementation of post-fracture care coordination services with the goal of reducing the incidence of hip and vertebral fractures by 25% by the year 2025. Mentorship to develop new, and improve existing, services is a key pillar of the CTF Partnership. The new 'Train the Trainer' programme of the CTF Partnership Mentorship pillar is presented in the session 'CTF Getting to Gold Framework' chaired by Prof. Kassim Javaid (CTF Steering Committee Co-chair, University of Oxford).[5]
As well, Dr Radmila Matijevic (Faculty of Medicine, University of Novi Sad, Serbia) is hosting a Meet-the-Expert Session on the efficacy and cost/benefit of FLS, services which ensure that all patients aged 50 years or over, who present to urgent care services with a fragility fracture, undergo fracture risk assessment and receive treatment in accordance with prevailing national clinical guidelines for osteoporosis.[6]
"Approximately 80% of individuals who have sustained a fracture related to osteoporosis do not receive the follow-up post-fracture care they need to decrease the risk of subsequent fractures," added Professor Cooper.
"As reflected in the WCO-IOF-ESCEO 2020 scientific programme, evidence shows that post-fracture care coordination programmes can dramatically improve osteoporosis treatment rates for fragility fracture patients and reduce secondary fractures and associated costs. It is essential that bone health experts continue to shine a spotlight on this critical topic, working in collaboration to advance policy change and encourage widespread implementation worldwide. "
Download abstracts here: https://virtual.wco-iof-esceo.org/sites/wco20/pdf/WCO20-AbstractBook.pdf
References:
[1] Abstract OCs8: An interactive benefits and budget impact calculator to estimate potential effects of fracture liaison services. R. Pinedo-Villanueva, A. Sami, S. Kolovos, E. Burn, M. Fujita, P. Halbout, C. Cooper, M. K. Javaid [2] Abstract OC36: Treatment initiation rate post hip fracture as a key indicator in an orthopaedic fracture liaison service. J. Delisle, B. Benoit, G. Y. Laflamme, S. Leduc, H. Ngyuen, P. Ranger, J. Fernandes [3] Abstracts NSS21-NSS23: Non-sponsored symposium 'Winning the political case for change - launch of a policy toolkit for osteoporosis and fragility fractures' [4] Abstracts NSS17-NSS20: Non-Sponsored Symposium 'Nationwide identification of vertebral fragility fractures: Collaborating with Radiology' [5] Abstracts NSS38-41: Non-sponsored Symposium 'CTF Getting to Gold Framework' [6] Abstract MTE12: Efficacy and cost/benefit of FLS. R. Matijevic, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia###
About the World Congress on Osteoporosis, Osteoarthritis & Musculoskeletal Diseases (WCO-IOF-ESCEO):
Held jointly by IOF and ESCEO, the WCO-IOF-ESCEO annual congress is the world's largest forum for the presentation of clinical research and new advances in the prevention and management of musculoskeletal disorders, including sarcopenia and frailty. WCO-IOF-ESCEO 2020 is held as a virtual Congress ( http://virtual.wco-iof-esceo.org/). The 2021 WCO-IOF-ESCO is planned in London, UK from April 8-11, 2021. For complete information visit http://virtual.wco-iof-esceo.org/ #OsteoCongress
About IOF:
The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as 260 patient, medical and research societies, work together to make fracture prevention and healthy mobility a worldwide heath care priority. https://www.osteoporosis.foundation @iofbonehealthAbout ESCEO:
The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) is a non-profit organization, dedicated to a close interaction between clinical scientists dealing with rheumatic disorders, pharmaceutical industry developing new compounds in this field, regulators responsible for the registration of such drugs and health policy makers, to integrate the management of osteoporosis and osteoarthritis within the comprehensive perspective of health resources utilization. The objective of ESCEO is to provide practitioners with the latest clinical and economic information, allowing them to organize their daily practice, in an evidence-based medicine perspective, with a cost-conscious perception. http://www.esceo.orgJournal
Osteoporosis International