Chih-Hsing Wu1, Shih-Te Tu2, Yin-Fan Chang3, Ding-Cheng Chan4, Jui-Teng Chien5, Chih-Hsueh Lin6, Sonal Singh7, Manikanta Dasari8, Jung-Fu Chen9, Keh-Sung Tsai10. 1. Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, 138 Sheng-Li Road, Tainan 70428, Taiwan; Institute of Gerontology, National Cheng Kung University College of Medicine, 138 Sheng-Li Road, Tainan 70428, Taiwan. Electronic address: paulo@mail.ncku.edu.tw. 2. Changhua Christian Hospital, LuKang Branch, 135 Nanhsiao Street, Changhua City 500, Taiwan. Electronic address: 10836@cch.org.tw. 3. Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, 138 Sheng-Li Road, Tainan 70428, Taiwan. Electronic address: yinfan@mail.ncku.edu.tw. 4. National Taiwan University Hospital Chu-Tung Branch, No. 52 Jshan Rd, Hsinchu County 31064, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 7 Chung Shan S Road, Taipei City 10002, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, No. 1 Changde St, Zongzheng District, Taipei City 10048, Taiwan. 5. Buddhist Dalin Tzuchi Hospital, 2, Min-Sheng Rd., Dalin, Chiayi, Taiwan. 6. Department of Family Medicine, China Medical University Hospital, No. 2 Yuh Der Road, Taichung, Taiwan. Electronic address: 5496@mail.cmuh.org.tw. 7. Department of Family Medicine and Community Health, Meyers Primary Care Institute, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655-0002, USA. Electronic address: Sonal.Singh@umassmemorial.org. 8. Complete HEOR Solutions, LLC.1046 Knapp Road, North Wales, PA 19454, USA. Electronic address: Manikanta.dasari@cheors.com. 9. Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan. Electronic address: 0722cjf@cgmh.org.tw. 10. Department of Internal Medicine, National Taiwan University Hospital, 7 Zhong Shan South Road, Taipei 10048, Taiwan. Electronic address: paulo@mail.ncku.edu.tw.
Abstract
OBJECTIVES: This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. METHODS: Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000-February 2017 inclusive) using the keywords 'osteoporosis', 'fractures', 'liaison', and 'service' to identify randomised controlled trials and observational studies of patients aged ≥50years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects and fixed-effects model. Outcomes of interest were incidence of bone mineral density (BMD) testing, treatment initiation, adherence, re-fractures, and mortality due to osteoporosis treatment. RESULTS: A total of 159 publications were identified for the systematic literature review; 74 controlled studies (16 RCTs; 58 observational studies) were included in the meta-analysis. Overall, 41 of 58 observational studies and 12 of 16 RCTs were considered of high quality. Compared with patients receiving usual care (or those in the control arm), patients receiving care from an FLS program had higher rates of BMD testing (48.0% vs 23.5%) and treatment initiation (38.0% vs 17.2%) and greater adherence (57.0% vs 34.1%). Unweighted average rates of re-fracture were 13.4% among patients in the control arm and 6.4% in the FLS arm. Unweighted average rates of mortality were 15.8% in the control arm and 10.4% in the FLS arm. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with BMD testing increased by 24 percentage points (95% confidence interval [CI] 0.18-0.29), 20 percentage points for treatment rates (95% CI 0.16-0.25), and 22 percentage points for adherence (95% CI 0.13-0.31) and absolute risk of re-fracture reduced by five percentage points (95% CI -0.08 to -0.03) and mortality reduced by three percentage points (95% CI -0.05 to -0.01). CONCLUSION: FLS programs improved outcomes of osteoporosis-related fractures, with significant increases in BMD testing, treatment initiation, and adherence to treatment and reductions in re-fracture incidence and mortality.
OBJECTIVES: This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. METHODS: Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000-February 2017 inclusive) using the keywords 'osteoporosis', 'fractures', 'liaison', and 'service' to identify randomised controlled trials and observational studies of patients aged ≥50years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects and fixed-effects model. Outcomes of interest were incidence of bone mineral density (BMD) testing, treatment initiation, adherence, re-fractures, and mortality due to osteoporosis treatment. RESULTS: A total of 159 publications were identified for the systematic literature review; 74 controlled studies (16 RCTs; 58 observational studies) were included in the meta-analysis. Overall, 41 of 58 observational studies and 12 of 16 RCTs were considered of high quality. Compared with patients receiving usual care (or those in the control arm), patients receiving care from an FLS program had higher rates of BMD testing (48.0% vs 23.5%) and treatment initiation (38.0% vs 17.2%) and greater adherence (57.0% vs 34.1%). Unweighted average rates of re-fracture were 13.4% among patients in the control arm and 6.4% in the FLS arm. Unweighted average rates of mortality were 15.8% in the control arm and 10.4% in the FLS arm. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with BMD testing increased by 24 percentage points (95% confidence interval [CI] 0.18-0.29), 20 percentage points for treatment rates (95% CI 0.16-0.25), and 22 percentage points for adherence (95% CI 0.13-0.31) and absolute risk of re-fracture reduced by five percentage points (95% CI -0.08 to -0.03) and mortality reduced by three percentage points (95% CI -0.05 to -0.01). CONCLUSION: FLS programs improved outcomes of osteoporosis-related fractures, with significant increases in BMD testing, treatment initiation, and adherence to treatment and reductions in re-fracture incidence and mortality.
Authors: B Mugnier; A Daumas; S Doddoli; S Belmeliani; A-L Couderc; B Mizzi; P Lévêque; P Villani Journal: Osteoporos Int Date: 2020-01-11 Impact factor: 4.507
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