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Singh S, van den Berg P, Fergusson K, Martins Pinto J, Koerner-Bungey T, Chan DCD, Boonnasa W, Javaid MK, Speerin R. Preventing the next fragility fracture: a cross-sectional survey of secondary fragility fracture prevention services worldwide. BMJ Open Qual 2023; 12:e002290. [PMID: 37783521 PMCID: PMC10565135 DOI: 10.1136/bmjoq-2023-002290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/07/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There has been an increasing awareness of the public health impact of fragility fractures due to osteoporosis and the imperative of addressing this health burden with well-designed secondary fragility fracture prevention services (SFFPS). The objectives of this survey, conducted within the international membership of the Fragility Fracture Network (FFN), were to identify gaps in services and identify the needs for further training and mentorship to improve the quality of SFFPS provided to patients who sustain fragility fractures. METHODS We conducted an electronic cross-sectional survey of FFN Secondary Fracture Prevention Special Interest Group (SIG) members from April 2021 to June 2021 using SurveyMonkey. The survey questions were developed by four SIG members from New Zealand, Australia, Canada and the Netherlands, who have experience in developing, implementing and evaluating SFFPS. The sampling framework was convenience sampling of all 1162 registered FFN Secondary Fracture Prevention SIG members. Descriptive analyses were performed for all variables and presented as frequencies and percentages. RESULTS 69 individuals participated in the survey, from 34 different countries over six continents, with a response rate of 6% (69/1162). Almost one-third of respondents (22/69) were from 15 countries within the European continent. Key findings included: (1) 25% of SFFPS only included patients with hip fracture; (2) less than 5% of SFFPS had any mandatory core competencies for training; (3) 38.7% of SFFPS were required to collect key performance indicators; and (4) 9% were collecting patient-reported outcome measures. CONCLUSIONS This survey identified key areas for improving SFFPS, including: expanding the reach of SFFPS to more patients with fragility fracture, developing international core competencies for health provider training, using key performance indicators to improve SFFPS and including the patient voice in SFFPS development. These findings will be used by the FFN to support SFFPS development internationally.
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Affiliation(s)
- Sonia Singh
- Fraser Health Authority, Surrey, British Columbia, Canada
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kim Fergusson
- Te Whatu Ora Health New Zealand-- Nelson Marlborough, Nelson, New Zealand
| | | | | | | | | | | | - Robyn Speerin
- The University of Sydney, Sydney, New South Wales, Australia
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Luo Z, Zhu W, Jiang C, He W, Zuo H. Characteristics of distal radius fractures in east China-an observational cohort study of 1954 individual fractures. BMC Musculoskelet Disord 2023; 24:627. [PMID: 37532978 PMCID: PMC10394874 DOI: 10.1186/s12891-023-06742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE To investigate the characteristics and seasonal patterns of distal radius fractures (DRFs) over the preceding five years, with the aim of establishing a clinical foundation for the prevention and management of such fractures within this region. METHODS Utilizing the Picture Archiving and Communication Systems (PACS), the clinical records of 1954 patients diagnosed with DRFs and admitted to the Affiliated Hospital of Jiangsu University between January 2017 and December 2021 were compiled. The analysis encompassed factors such as age, gender, visitation timing, fracture side, and presence of osteoporosis. RESULTS Out of the total 1954 distal radius fractures, 731 were males (37.4%) and the male to female ratio was 0.59:1. The median age of patients with DRFs was 56 years, with the 25th percentile being 38 years and the 75th percentile being 67 years. The average age was 50 years (standard deviation 23.3) and 1033 cases (52.7%) occurred on the left side, 885 cases (45.1%) on the right side, and 36 cases (1.8%) were bilateral, with the left side being the most frequently affected. The age group of 61-70 years (23.9%, 467/1954) exhibited the highest proportion, and the most prominent age group for males was 11-20 years (23.8%, 174/731), whereas for females it was 61-70 years (30.83%, 377/1223). In the 50 years and older group, there were 276 males and 991 females (ratio 1:3.59), with osteoporosis in 536 cases, accounting for 42.03% of the group. In terms of seasonal distribution, the highest incidence occurred during the summer and autumn months (55.1%, 1076/1954) and there were gender differences in different seasons. CONCLUSION In east China, DRFs were predominantly female and left-sided, with the highest proportion in the age group of 61-70 years and in summer and autumn. Furthermore, gender differences were observed between the warm and cold seasons.
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Affiliation(s)
- Zhenyu Luo
- Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu, China
| | - Wei Zhu
- Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu, China
| | - Chao Jiang
- Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu, China
| | - Wei He
- Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu, China
| | - Hua Zuo
- Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu, China.
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Yang X, Kuang Z, Yang X, Hu X, Luo P, Lai Q, Zhang B, Zhang X, Wei Y. Facile synthesis of curcumin-containing poly(amidoamine) dendrimers as pH-responsive delivery system for osteoporosis treatment. Colloids Surf B Biointerfaces 2023; 222:113029. [PMID: 36436402 DOI: 10.1016/j.colsurfb.2022.113029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Osteoporosis is an age-related metabolic disease of bone, resulting in bone pain and even bone fragility and brittle fracture. Inhibiting overactive osteoclasts while promoting osteoblast activity is an ideal way to treat osteoporosis. Previous studies have demonstrated that natural compounds, such as curcumin (Cur) have dual roles both in promoting bone formation and inhibiting bone resorption, making them promising candidates for osteoporosis treatment. However, their poor water solubility, high dosage of curative effect and significant toxicity to other organs have largely limited their clinical translations. In this study, a novel method was reported to conjugate Cur and poly(amidoamine) dendrimers (PAD) using hexachlorocyclotriphosphazene (HCCP) as the linkage through a one-pot reaction, forming stable and uniform Cur loaded nanospheres (HCCP-Cur-PAD, HCP NPs). Owing to the hydrophilicity of PAD and hydrophobicity of Cur, HCP NPs can self-assemble into nanoparticles with particle size of 138.8 ± 78.7 nm and display excellent water dispersity. The loading capacity of Cur can reach 27.2% and it can be released from HCP NPs with pH-responsiveness. In vitro experimental results demonstrated that the HCP NPs entered lysosomes by endocytosis and proved dual anti-osteoporosis effects of inhibiting osteoclasts and promoting osteoblasts.
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Affiliation(s)
- Xiaowei Yang
- Department of Orthopedics, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi 330006, PR China; Department of Chemistry, Nanchang University, 999 Xuefu Avenue, Nanchang 330031, PR China
| | - Zhihui Kuang
- Department of Orthopedics, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi 330006, PR China
| | - Xinmin Yang
- Department of Orthopedics, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi 330006, PR China
| | - Xin Hu
- Department of Chemistry, Nanchang University, 999 Xuefu Avenue, Nanchang 330031, PR China
| | - Peng Luo
- Department of Orthopedics, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi 330006, PR China; Department of Chemistry, Nanchang University, 999 Xuefu Avenue, Nanchang 330031, PR China
| | - Qi Lai
- Department of Orthopedics, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi 330006, PR China
| | - Bin Zhang
- Department of Orthopedics, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi 330006, PR China.
| | - Xiaoyong Zhang
- Department of Chemistry, Nanchang University, 999 Xuefu Avenue, Nanchang 330031, PR China.
| | - Yen Wei
- Department of Chemistry and the Tsinghua Center for Frontier Polymer Research, Tsinghua University, Beijing 100084, PR China.
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Mitchell PJ, Chan DCD, Lee JK, Tabu I, Alpuerto BB. The global burden of fragility fractures - what are the differences, and where are the gaps. Best Pract Res Clin Rheumatol 2022; 36:101777. [PMID: 36089481 DOI: 10.1016/j.berh.2022.101777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current burden of fragility fractures is enormous, and it is set to increase rapidly in the coming decades as humankind enters a new demographic era. The purpose of this review is to consider, in different settings: • The human and economic toll of fragility fractures. • Risk factors for fragility fractures. • Current acute management of fragility fractures. • Current care gaps in both secondary and primary fracture prevention. A summary of global, regional, and national initiatives to improve the quality of care is provided, in addition to proposals for the research agenda. Systematic approaches to improve the acute care, rehabilitation and prevention of fragility fractures need to be developed and implemented rapidly and at scale in high-, middle- and low-income countries throughout the world. This must be an essential component of our response to the ageing of the global population during the remainder of the current United Nations - World Health Organization "Decade of Healthy Ageing".
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Affiliation(s)
- Paul James Mitchell
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Australia; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Synthesis Medical NZ Limited, Pukekohe, New Zealand.
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Changde St, Taipei, 100, Taiwan.
| | - Joon-Kiong Lee
- Beacon Hospital, 1, Jalan 215, Section 51, Off Jalan Templer, 46050, Petaling Jaya, Selangor, Malaysia.
| | - Irewin Tabu
- Department of Orthopaedics, University of the Philippines - Philippine General Hospital, Manila, Philippines; Institute on Aging-National Institutes of Health, UP Manila, Philippines.
| | - Bernardino B Alpuerto
- Department of Orthopaedics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
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Fracture liaison: A crucial tool in the fight against fragility fracture. Maturitas 2022; 165:26-32. [PMID: 35863271 DOI: 10.1016/j.maturitas.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/24/2022]
Abstract
Over the course of the first half of the 21st century the age structure of the human population will have undergone dramatic change, leading to what has been described by the Fragility Fracture Network and the International Osteoporosis Foundation as a new demographic era. In the absence of widespread implementation of systematic approaches to chronic disease management, and prevention and treatment of osteoporosis and fragility fractures in particular, fracture rates among older people will increase significantly by mid-century. The purpose of this narrative review is to characterise the current and projected burden of fragility fractures, evaluate current gaps in delivery of best clinical practice, and summarise the literature on the Fracture Liaison Service (FLS) model of care. A definition of FLS is provided, in addition to findings of systematic reviews and associated meta-analyses conducted to assess the clinical and economic benefits of FLS. Initiatives intended to enable benchmarking of the quality of care provided by FLS are reviewed, including the flagship International Osteoporosis Foundation Capture the Fracture® Programme and examples of national clinical standards for FLS from several countries. The emergence of national clinical registries to facilitate benchmarking against clinical standards is also considered. Finally, a precis is provided of several global and regional initiatives that aim to support changes in healthcare policy to provide funding, at scale, to support widespread implementation of FLS.
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