E-Poster Presentation 30th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2020

Post-Fracture Care (PFC) Programs: A Literature Assessment of Where Secondary Fracture (Fx) Prevention is Today (#95)

Kirtan Ganda 1 2 , Kristina Åkesson 3 , Cynthia Deignan 4 , Amy Volpert 5 , Keyla Brooks 6 , David Lee 4 , Andrea Singer 7
  1. Concord Repatriation General Hospital, Concord, NSW, Australia
  2. Universsity of Sydney, Sydney, NSW, Australia
  3. Lund University and Skåne University Hospital, Malmö, Sweden
  4. Amgen Inc., Thousand Oaks, California, USA
  5. BioScience Communications, New York, NY, USA
  6. UCB Pharma, Brussels, Belgium
  7. MedStar Georgetown University Hospital, Washington, D.C., USA

Purpose: PFC programs, notably Fx liaison services (FLSs), identify, investigate, and manage Pts for secondary Fx prevention. Despite an increase in PFC program literature in the last decade, limited information exists on their diversity and success. This literature review describes PFC program types, distribution and outcomes.

Methods: This analysis included peer-reviewed articles from 2003—2018; search terms related to adult, secondary Fx prevention programs. Articles belonged to 5, non-mutually exclusive areas: PFC definition i.e. intervention types and goals; PFC permutations in real-world practice; clinical effectiveness; economics; and implementation science. Primary objective was quantitative and qualitative assessment of PFC programs in these areas; geographic variations included.

Results: 647 of 729 articles were included (primary Fx prevention excluded; Figure); most published since 2013. Most programs fall into 2 categories—FLS out-Pt and orthogeriatric Fx, which differ in target populations, Fx types, and Pt outcomes. Most data on FLSs focussed on effectiveness and cost-benefit analyses rather than quality of life and social/disease burden. More intensive and coordinated FLS programs were associated with better outcomes (Ganda OI 2013). Some lower intensity interventions e.g. providing Pts with literature to discuss with primary care providers, also improved outcomes (Majumdar OI 2017). The number of articles per country did not correlate with population size, osteoporosis prevalence, or hip Fx incidence. Most articles originated from Europe and North America—several countries had few PFC programs but high hip Fx incidence.

Conclusions: PFC programs today comprise primarily of FLS and geriatric Fx programs. While primary goals and Pt populations differ, both demonstrated Pt benefit. Areas of improvement include expansion/adaptation of PFC for lower population density regions/limited resources and improvements in established programs. Data gaps remain around sustainability and standardisation of PFC program outcomes, including long-term Fx data. Future work may consider remote digital programs and trends among age subgroups.

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