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Martínez-Díaz-Guerra G, Hawkins Carranza F, Librizzi S. [Translated article] Socioeconomic status, osteoporosis and fragility fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00144-9. [PMID: 39128698 DOI: 10.1016/j.recot.2024.08.007] [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: 03/04/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 08/13/2024] Open
Abstract
Low socioeconomic status (SES) is associated with a higher risk of fragility fractures, as well as higher mortality in the first-year post-fracture. The SES variables that have the greatest impact are educational level, income level, and cohabitation status. Significant disparities exist among racial and ethnic minorities in access to osteoporosis screening and treatment. In Spain, a higher risk of fractures has been described in people with a low-income level, residence in rural areas during childhood and low educational level. The civil war cohort effect is a significant risk factor for hip fracture. There is significant geographic variability in hip fracture care, although the possible impact of socioeconomic factors has not been analyzed. It would be desirable to act on socioeconomic inequalities to improve the prevention and treatment of osteoporotic fractures.
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Affiliation(s)
- G Martínez-Díaz-Guerra
- Servicio de Endocrinología, Instituto de Investigación Sanitaria «imas12», Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
| | - F Hawkins Carranza
- Servicio de Endocrinología, Instituto de Investigación Sanitaria «imas12», Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - S Librizzi
- Servicio de Endocrinología, Instituto de Investigación Sanitaria «imas12», Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Martínez-Díaz-Guerra G, Hawkins Carranza F, Librizzi S. Socioeconomic status, osteoporosis and fragility fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00110-3. [PMID: 38909956 DOI: 10.1016/j.recot.2024.06.010] [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: 03/04/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024] Open
Abstract
Low socioeconomic status (SES) is associated with a higher risk of fragility fractures, as well as higher mortality in the first year post-fracture. The SES variables that have the greatest impact are educational level, income level, and cohabitation status. Significant disparities exist among racial and ethnic minorities in access to osteoporosis screening and treatment. In Spain, a higher risk of fractures has been described in people with a low income level, residence in rural areas during childhood and low educational level. The Civil War cohort effect is a significant risk factor for hip fracture. There is significant geographic variability in hip fracture care, although the possible impact of socioeconomic factors has not been analyzed. It would be desirable to act on socioeconomic inequalities to improve the prevention and treatment of osteoporotic fractures.
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Affiliation(s)
- G Martínez-Díaz-Guerra
- Servicio de Endocrinología, Instituto de Investigación Sanitaria «imas12», Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - F Hawkins Carranza
- Servicio de Endocrinología, Instituto de Investigación Sanitaria «imas12», Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - S Librizzi
- Servicio de Endocrinología, Instituto de Investigación Sanitaria «imas12», Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
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Martínez-Laguna D, Carbonell Abella C, Bastida JC, González M, Micó-Pérez RM, Vargas F, Díaz Torres E, Canals L. Secondary fracture prevention in Spanish primary care: results of the PREFRAOS Study. Arch Osteoporos 2024; 19:35. [PMID: 38722400 PMCID: PMC11081989 DOI: 10.1007/s11657-024-01394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
This study demonstrated a large treatment gap in elderly subjects experiencing fragility fracture in Spanish primary care, a low treatment persistence among subjects who do receive treatment, and more than one-quarter having no follow-up visits post-fracture. These data highlight the need to improve secondary fracture prevention in primary care. PURPOSE To describe osteoporosis (OP) treatment patterns and follow-up in subjects with fragility fracture seen in Spanish primary care (PC). METHODS This observational, retrospective chart review included subjects aged ≥ 70 years listed in the centers' records (November 2018 to March 2020), with ≥ 1 fragility fracture and prior consultation for any reason; subjects who had participated in another study were excluded. Outcomes included OP treatments and follow-up visits post-fragility fracture. RESULTS Of 665 subjects included, most (87%) were women; overall mean (SD) age, 82 years. Fewer than two thirds (61%) had received any prior OP treatment (women, 65%; men, 38%); of these, 38% had received > 1 treatment (women, 25%; men, 13%). Among treated subjects, the most frequent first-line treatments were alendronate (43%) and RANKL inhibitor denosumab (22%), with a higher discontinuation rate and shorter treatment duration observed for alendronate (discontinuation, 42% vs 16%; median treatment duration, 2.5 vs 2.1 years). Over one-quarter (26%) of subjects had no follow-up visits post-fragility fracture, with this gap higher in women than men (35% versus 25%). The most common schedule of follow-up visits was yearly (43% of subjects with a fragility fracture), followed by half-yearly (17%) and biennial (10%), with a similar trend in men and women. Most OP treatments were prescribed by PC physicians, other than teriparatide and zoledronate. CONCLUSIONS Across Spanish PC, we observed a large gap in the treatment and follow-up of elderly subjects experiencing a fragility fracture. Our data highlights the urgent need to improve secondary fracture prevention in PC.
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Affiliation(s)
- Daniel Martínez-Laguna
- Health Center Sant Martí de Provençals, C/ Fluvià 211, Barcelona, Spain.
- GREMPAL Research Group, IDIAP Jordi Gol, Barcelona, Spain.
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Castañeda S, Navarro Ceballos C, Usón Jaeger J, de Miguel Benadiba C, Gómez Martín E, Martínez Díaz-Guerra G, Alvarez-Galovich L. Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts. Geriatrics (Basel) 2024; 9:24. [PMID: 38525741 PMCID: PMC10961758 DOI: 10.3390/geriatrics9020024] [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: 11/01/2023] [Revised: 01/15/2024] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Vertebral fragility fractures (VFF) pose a challenge for appropriate care. The aim of this study was to develop consensus recommendations for the management of VFF in older people from a multidisciplinary approach. Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was defined as 80% of responses of 8 (agree) and 9 (strongly agree) on a Likert scale. Consensus was achieved in 22 recommendations (62.8%). The experts agreed on the need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX®), did not achieve an agreed consensus. Also, there was consensus regarding the administration of calcium/vitamin D supplements, the withdrawal of toxic habits, and personalized physical exercise. Participants agreed on the administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. Although there was multidisciplinary agreement on diagnostic tests and non-pharmacological and pharmacological treatment in frail older people, therapeutic objectives should be individualized for every patient. In addition to the specific recommendations, close collaboration between the geriatrician and the primary care physician is essential for the optimal chronic management of frail patients with fragility fractures.
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Affiliation(s)
- Santos Castañeda
- Rheumatology Service, Hospital Universitario La Princesa, IIS-Princesa, 28006 Madrid, Spain
- Cátedra UAM-Roche, EPID-Future, Department of Medicine, Autonomous University of Madrid (UAM), 28049 Madrid, Spain
| | | | - Jaqueline Usón Jaeger
- Rheumatology Service, Hospital General Universitario de Móstoles, Móstoles, 28935 Madrid, Spain;
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Capdevila-Reniu A, Navarro-López M, Sapena V, Jordan AI, Arroyo-Huidobro M, López-Soto A. Predictive factors of osteoporotic hip fracture in octogenarians. Rev Clin Esp 2024; 224:77-85. [PMID: 38237859 DOI: 10.1016/j.rceng.2024.01.001] [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: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE This study aims to identify the risk factors associated with osteoporotic hip fractures in octogenarians and seeks to refine primary prevention strategies for these fractures. MATERIAL AND METHODS We conducted a case-control study involving individuals aged 79 years and older with hip fractures, comparing them to age- and sex-matched controls without a history of hip fractures. We collected epidemiological, clinical, anthropometric, and analytical factors. We evaluated the presence of osteoporosis using bone densitometry. We defined sarcopenia according the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). RESULTS Ninety-five patients per group were analyzed, with a mean age of 82 years, of which 74% were women. The multivariate analysis included statistically significant factors found in the univariate analysis (p < 0.05). These factors included the Barthel Index, nutritional assessment using the CONUT tool, folic acid, vitamin D deficiency, presence of previous fractures, loss of visual acuity, bicipital circumference, sarcopenia, and osteoporosis (densitometry in the neck of the femur). The Nutritional state (OR: 0.08 [0.01-0.61]), the folic acid levels (OR 0.32 [0.1-1]), and a loss of visual acuity (OR 33.16 [2.91-377.87]) were the independent risk factors associated with hip fracture. CONCLUSIONS The assessment of nutritional status in elderly patients, coupled with a comprehensive geriatric assessment, represents easily reproducible and cost-effective tools. These tools can effectively aid in identifying individuals at risk of hip fractures, thereby contributing to more targeted and efficient preventive measures.
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Affiliation(s)
- A Capdevila-Reniu
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - M Navarro-López
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - V Sapena
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain; Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A I Jordan
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Arroyo-Huidobro
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - A López-Soto
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Talevski J, Beauchamp A, Bird S, Daly RM. Integrating post-fracture care into the primary care setting (interFRACT): Protocol for a mixed-methods study to co-design a care program to improve rates of osteoporosis and fracture treatment. BMJ Open 2023; 13:e067560. [PMID: 37076158 PMCID: PMC10124312 DOI: 10.1136/bmjopen-2022-067560] [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] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Despite evidence showing that timely diagnosis and appropriate pharmacological treatment of osteoporosis reduces subsequent fracture rates, osteoporosis remains significantly underdiagnosed and undertreated. The large and ongoing treatment gap for osteoporosis and associated fragility fractures could be addressed by considering systematic approaches for post-fracture care in the primary care setting. This study will develop the Integrating Post-Fracture Care into Primary Care (interFRACT) care program that aims to enhance diagnosis and treatment of osteoporosis and improve initiation and adherence to fracture prevention strategies for older adults in the primary care setting. METHODS AND ANALYSIS This mixed-methods study will follow an established co-design approach that involves six steps; the first three aim to gain an understanding of the consumer experience and needs, while the latter three focus on how to improve that experience through design and action. This will include: development of a Stakeholder Advisory Committee to provide guidance on all aspects of study design, including implementation, evaluation and dissemination; interviews with primary care physicians to explore beliefs and attitudes towards osteoporosis and fracture treatment; interviews with consumers (older adults with a diagnosis of osteoporosis and/or fragility fracture) to identify current needs for osteoporosis treatment and fracture prevention; a series of co-design workshops to develop the components of the interFRACT care program based on published guidance and findings from interviews; and a feasibility study with primary care physicians to determine the usability and acceptability of the interFRACT care program. ETHICS AND DISSEMINATION Ethical approval was obtained from Deakin University Human Research Ethics Committee (approval number: HEAG-H 56_2022). Study results will be published in peer-reviewed journals, presented at national and international conferences, and collated in reports for participating primary care practices.
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Affiliation(s)
- Jason Talevski
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- The Australian Institute of Musculoskeletal Sciences (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- School of Rural Health, Monash University, Warragul, Victoria, Australia
| | - Alison Beauchamp
- School of Rural Health, Monash University, Warragul, Victoria, Australia
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Stefanie Bird
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Talevski J, Daly RM. Additional Insights on the Osteoporosis Care Gap. J Bone Miner Res 2022; 38:615-616. [PMID: 36484516 DOI: 10.1002/jbmr.4747] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Jason Talevski
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Letter to the Editor Regarding "Failure of Conservatively Managed Traumatic Vertebral Compression Fractures: A Systematic Review". World Neurosurg 2022; 167:247. [PMID: 36793173 DOI: 10.1016/j.wneu.2022.07.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/20/2022]
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