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Archives of Osteoporosis

, 14:19 | Cite as

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

  • Andréa Senay
  • Sylvie Perreault
  • Josée Delisle
  • Suzanne N. Morin
  • Jean-Pierre Raynauld
  • Andreea Banica
  • Yves Troyanov
  • Pierre Beaumont
  • Alain Jodoin
  • G. Yves Laflamme
  • Stéphane Leduc
  • Jean-Marc Mac-Thiong
  • Hai Nguyen
  • Pierre Ranger
  • Dominique M. Rouleau
  • Julio C. FernandesEmail author
Original Article

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.

Keywords

Osteoporosis Fragility fracture Secondary fracture prevention Fracture liaison service Fracture management Cohort study 

Notes

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).

Compliance with ethical standards

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.

Supplementary material

11657_2019_571_MOESM1_ESM.docx (52 kb)
ESM 1 (DOCX 52 kb)

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Andréa Senay
    • 1
    • 2
  • Sylvie Perreault
    • 1
    • 3
  • Josée Delisle
    • 2
    • 4
  • Suzanne N. Morin
    • 5
  • Jean-Pierre Raynauld
    • 6
  • Andreea Banica
    • 2
    • 4
  • Yves Troyanov
    • 2
  • Pierre Beaumont
    • 2
  • Alain Jodoin
    • 2
  • G. Yves Laflamme
    • 2
    • 4
  • Stéphane Leduc
    • 2
    • 4
  • Jean-Marc Mac-Thiong
    • 2
  • Hai Nguyen
    • 4
  • Pierre Ranger
    • 2
    • 4
  • Dominique M. Rouleau
    • 2
  • Julio C. Fernandes
    • 2
    • 4
    • 7
    • 8
    Email author
  1. 1.Faculty of PharmacyUniversité de MontréalMontrealCanada
  2. 2.CIUSSS Nord de l’Ile de MontréalHôpital du Sacré-Coeur de MontréalMontrealCanada
  3. 3.Sanofi Aventis endowment Research Chair in Optimal Drug UseUniversité de MontréalMontrealCanada
  4. 4.CIUSSS Nord de l’Ile de MontréalHôpital Jean-TalonMontrealCanada
  5. 5.McGill University Health CentreMontreal General HospitalMontrealCanada
  6. 6.Institut de rhumatologie de MontréalMontrealCanada
  7. 7.Faculty of MedicineUniversité de MontréalMontrealCanada
  8. 8.Chaire de recherche en orthopédie de l’UdeM au CIUSS NIMMontrealCanada

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