Rationale, study design, and descriptive data of the Lucky Bone™ Fracture Liaison Service
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.
This paper describes the study design, implementation, and baseline characteristics of a multidisciplinary Fracture Liaison Service (FLS) in Quebec (Canada).
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.
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.
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.
KeywordsOsteoporosis Fragility fracture Secondary fracture prevention Fracture liaison service Fracture management Cohort study
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.
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.
- 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 94:569–573Google 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. 99pGoogle 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 25:1345–1355CrossRefGoogle 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:e9012CrossRefGoogle 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 182:1864–1873CrossRefGoogle 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 42:929–942CrossRefGoogle 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 843:1–129Google Scholar
- 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 62:243–250CrossRefGoogle 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 51:1171–1178CrossRefGoogle 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-S252Google Scholar
- 32.Régie de l’assurance maladie du Québec (2017) Rapport annuel de gestion 2016–2017:107–112Google 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